Pediatric Diabetic Ketoacidosis: Is Fluid Replacement Rate Associated with Cerebral Edema?

Does rate of rehydration affect the development of cerebral edema in children with diabetic ketoacidosis (DKA)? To find out, investigators used magnetic resonance diffusion–weighted imaging to quantify subclinical cerebral edema in children (ages 8 to 18 years) with DKA who were randomized to two intravenous fluid regimens.

Eight children (median age, 12 years) received a rapid protocol: a 20 mL/kg bolus of normal saline followed by replacement of two thirds of their fluid deficit over the first 24 hours and the remaining third over the next 24 hours; urine output was replaced at half of urine volume while serum glucose level was above 250 mg/dL. Ten children (median age, 15 years) were given a slower protocol: a 10 mL/kg bolus of normal sal…