Quiz: What Do You Know About Diabetic Ketoacidosis?

Romesh Khardori, MD, PhD


December 03, 2015

Initial correction of fluid loss is either by isotonic sodium chloride solution or by lactated Ringer solution. The recommended schedule for restoring fluids is as follows:

  • Administer 1-3 L during the first hour.

  • Administer 1 L during the second hour.

  • Administer 1 L during the following 2 hours.

  • Administer 1 L every 4 hours, depending on the degree of dehydration and central venous pressure readings.

When the patient becomes euvolemic, the physician may switch to half-isotonic sodium chloride solution, particularly if hypernatremia exists. Isotonic saline should be administered at a rate appropriate to maintain adequate blood pressure and pulse, urine output, and mental status.

If a patient is severely dehydrated and significant fluid resuscitation is needed, switching to a balanced electrolyte solution (eg, Normosol™-R, in which some of the chloride in isotonic saline is replaced with acetate) may help to avoid the development of hyperchloremic acidosis.

When blood sugar decreases to less than 180 mg/dL, isotonic sodium chloride solution is replaced with 5%-10% dextrose with half-isotonic sodium chloride solution.

After initial stabilization with isotonic saline, switch to half-normal saline at 200-1000 mL/h (half-normal saline matches losses due to osmotic diuresis).

For more the treatment of DKA, read here.

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