The debate for the optimum sodium concentration in the rehydration solution in diabetic ketoacidosis (DKA) persists till the moment. The aim was to compare the outcome of 0.9% saline versus 0.45% saline in children with moderate and severe (DKA) regarding the effect on serum electrolytes, duration of DKA resolution and the incidence of hyperchloremia. A retrospective analysis of 121 children with moderate or severe DKA was done. After the initial 4 h in which both groups received normal saline, patients were divided into two groups continuing on 0.9% (N=72) or switched to 0.45% saline (N=49). Serum chloride and Cl/Na ratios were significantly higher in 0.9% saline group at 4 and 8 h. The 0.9% saline group had significantly higher proportion of hyperchloremia at 4 and 8 h (P value: 0.002, 0.02). The median duration of correction of DKA (14 h among 0.9% saline versus 10 h among 0.45% saline) without significant difference (P value= 0.43). The change in plasma glucose, effective osmolarity, corrected Na levels were comparable between groups. There is an unavoidable iatrogenically induced rise in serum chloride with higher incidence of hyperchloremia with the use of normal saline in rehydration of children presenting in DKA and shock. The use of 0.45% saline as post-bolus rehydration fluid is not associated with a decline in the corrected serum sodium concentration and does not affect the rate of correction of acidosis or rate of drop in blood glucose or duration of DKA resolution when compared to normal saline.

中文翻译：

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在中度和重度糖尿病酮症酸中毒中使用0.9％生理盐水和0.45％生理盐水进行补液的结果

关于糖尿病性酮症酸中毒（DKA）中补液中最佳钠浓度的争论一直持续到现在。目的是比较中度和重度（DKA）儿童的0.9％生理盐水和0.45％生理盐水的结局，以了解它们对血清电解质，DKA分解持续时间和高氯血症发生率的影响。回顾性分析121例中度或重度DKA患儿。两组均开始接受生理盐水的最初4小时后，将患者分为两组，继续以0.9％（N = 72）或切换为0.45％生理盐水（N = 49）。0.9％生理盐水组在4h和8h时血清氯和Cl / Na的比例显着升高。0.9％的盐水组在4和8 h时高氯血症的比例显着更高（P值：0.002，0.02）。DKA校正的中位数持续时间（0.9％盐水中为14小时，而0.45％盐水中为10小时）无显着差异（P值= 0.43）。两组之间的血浆葡萄糖变化，有效渗透压，校正的Na水平相当。在患有DKA和休克的儿童补液中，使用生理盐水不可避免地导致由医源性引起的血清氯化物升高，高氯血症的发生率更高。与正常人相比，使用0.45％的生理盐水作为推注后补液不会降低校正后的血清钠浓度，也不会影响酸中毒的校正率，血糖下降率或DKA缓解的持续时间。盐水。有效渗透压，校正后的Na水平在各组之间具有可比性。在患有DKA和休克的儿童补液中使用生理盐水，不可避免的是医源性诱导的血清氯化物升高，高氯血症的发生率更高。与正常人相比，使用0.45％的生理盐水作为推注后补液不会降低校正后的血清钠浓度，也不会影响酸中毒的校正率，血糖下降率或DKA缓解的持续时间。盐水。有效渗透压，校正后的Na水平在各组之间具有可比性。在患有DKA和休克的儿童补液中，使用生理盐水不可避免地导致由医源性引起的血清氯化物升高，高氯血症的发生率更高。与正常人相比，使用0.45％的生理盐水作为推注后补液不会降低校正后的血清钠浓度，也不会影响酸中毒的校正率，血糖下降率或DKA缓解的持续时间。盐水。