Background: Diabetic ketoacidosis (DKA) requires large volumes of fluid resuscitation. Excessive administration of high chloride-containing intravenous (IV) fluids can cause hyperchloremia. Data on the association of hyperchloremia with acute kidney injury (AKI) and prolonged metabolic acidosis among children with DKA are limited. Objective: To investigate the association between IV solution-induced hyperchloremia, metabolic acidosis, and AKI among pediatric patients with DKA. Methods: This retrospective cohort study examined the records of pediatric patients with DKA to note serum chloride levels and compute total chloride infused, compared per time interval by repeated-measures ANOVA. The association of hyperchloremia with AKI and prolonged metabolic acidosis was examined using the Fisher exact test. Results: Of 280 cases of DKA, 167 records were eligible, of whom 158 (94.6%) developed hyperchloremia and 36 (21%) had AKI. While hyperchloremia was not associated with AKI ( P = 0.21), it was associated with a significant decrease in urine output ( P = 0.008). DKA resolution was observed at mean ± standard deviation of 21.3 ± 14.0 hour by closure of anion gap, 25.5 ± 14.8 hour by the rise of pH and 29.7 ± 14. 9 hours by improvement in serum bicarbonate levels. Conclusions: The study showed that hyperchloremia is common during fluid resuscitation and is associated with prolonged metabolic acidosis and decreased urine output. In fluid resuscitation, the volume and chloride content of IV solutions should always be considered to prevent adverse outcomes.
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Guina et al. (2024) studied this question.
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