{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T05:47:54Z","timestamp":1793771274668,"version":"4.6.1"},"reference-count":30,"publisher":"American Diabetes Association","issue":"9","license":[{"start":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T00:00:00Z","timestamp":1624924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,9,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>The current analysis involved moderate or severe DKA episodes (n = 714) in children age &amp;lt;18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial. Children were assigned to one of four treatment groups using a 2 \u00d7 2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The rate of change of pH did not differ by treatment arm, but Pco2 increased more rapidly in the fast versus slow fluid infusion arms during the initial 4 h of treatment. The anion gap also decreased more rapidly in the fast versus slow infusion arms during the initial 4 and 8 h. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 h. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% versus 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) versus the slow arms (35.2%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and Pco2 than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc20-3113","type":"journal-article","created":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T17:45:13Z","timestamp":1624988713000},"page":"2061-2068","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":34,"title":["Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis"],"prefix":"10.2337","volume":"44","clinical-trial-number":[{"clinical-trial-number":"nct00629707","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-9273","authenticated-orcid":false,"given":"Arleta","family":"Rewers","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Colorado Children\u2019s Hospital, University of Colorado\u2013Denver School of Medicine, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California Davis Health, University of California, Davis, School of Medicine, Sacramento"},{"name":"Department of Pediatrics, University of California Davis Health, University of California, Davis, School of Medicine, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Stoner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nationwide Children\u2019s Hospital, Ohio State University College of Medicine, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aris","family":"Garro","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E.","family":"Bennett","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Nemours\/Alfred I. duPont Hospital for Children, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly S.","family":"Quayle","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, St. Louis Children\u2019s Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Schunk","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sage R.","family":"Myers","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie K.","family":"McManemy","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Boston Children\u2019s Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Trainor","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. 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