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In a 13-center prospective randomized controlled trial, investigators compared neurologic outcomes among children with diabetic ketoacidosis (DKA) given one of four intravenous fluid regimens: 0.45% or 0.9% sodium chloride delivered by either a fast rate (replacement of an assumed 10% body weight fluid deficit over 36 hours) or a slow rate (replacement of an assumed 5% body weight fluid deficit over 48 hours). Insulin and dextrose dosing were standardized across groups per protocol.
Over a 5-year period, 1255 children (average age, 12 years) presented with 1389 episodes of DKA (average pH, 7.16; average serum bicarbonate, 9 mmol/L). During treatment, 48 patients (3.5%) had a decline in mental status — the primary outcome (defined as two cons…