Effect of rehydration fluid with 75 mmol/L of sodium on serum sodium concentration and serum osmolality in young patients with diabetic ketoacidosis

Mayo Clin Proc. 1994 Dec;69(12):1149-53. doi: 10.1016/s0025-6196(12)65766-8.

Abstract

Objective: To evaluate whether rehydration of young patients with diabetic ketoacidosis (DKA) by use of a solution that contained 75 mmol/L of sodium would be associated with a decline in serum sodium concentrations.

Design: We retrospectively studied 18 episodes of moderate to severe DKA (mean plasma bicarbonate concentration of 7.8 +/- 0.9 mmol/L) in 17 patients younger than 18 years of age who had been examined at the Mayo Clinic between 1986 and 1990.

Material and methods: All patients had received an initial fluid bolus (about 20 mL/kg) of 0.9% saline or Ringer's lactate (or both), followed by rehydration with solutions that contained 75 mmol/L of sodium at rates of approximately 3,000 mL/m2 per day. Mean corrected and uncorrected serum sodium concentrations and effective serum osmolality (before and after administration of the fluid bolus and at 6 and 12 hours into treatment) were compared by use of the paired Student t test.

Results: After 12 hours of therapy, we found a significant increase in the mean uncorrected serum sodium level from 135.1 +/- 0.9 mmol/L to 138.1 +/- 0.7 mmol/L (P < 0.05), whereas the mean corrected serum sodium value declined slightly from 143.1 +/- 1.1 mmol/L to 140.4 +/- 0.7 mmol/L (statistically not significant). Serum osmolality based on uncorrected serum sodium concentrations decreased at a rate of 2.6 mmol/kg per hour during the first 6 hours of treatment and remained stable thereafter.

Conclusion: In 18 episodes of DKA in young patients, rehydration with fluids that contained 75 mmol/L of sodium at rates of approximately 3,000 mL/m2 per day after administration of a fluid bolus of 0.9% saline or Ringer's lactate (or both) was not associated with a decline in the uncorrected serum sodium concentration.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Diabetic Ketoacidosis / blood*
  • Diabetic Ketoacidosis / therapy*
  • Female
  • Fluid Therapy*
  • Humans
  • Infant
  • Male
  • Osmolar Concentration
  • Rehydration Solutions / administration & dosage*
  • Retrospective Studies
  • Sodium / administration & dosage*
  • Sodium / analysis
  • Sodium / blood*

Substances

  • Rehydration Solutions
  • Sodium