Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis

<b>IMPORTANCE: </b>Fluid replacement to correct dehydration, acidosis and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA) but little is known about optimal fluid infusion rates and electrolyte content. <p><b>OBJECTIVE</b><b>: </b><a>To</a> evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. </p> <p><b>DESIGN, SETTING, PaRTICIPANTS:</b><b> </b> The current analysis involved moderate or severe DKA episodes (n=714) in children <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial.</p> <p><b>INTERVENTION:</b> Children were assigned to one of four treatment groups using a 2-by-2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration). </p> <p><b>Results: </b>The rate of change of pH did not differ by treatment arm, but PCO₂increased more rapidly in the fast vs slow fluid infusion arms during the initial 4 hours of treatment. The anion gap also decreased more rapidly in the fast vs slow infusion arms during the initial 4 and 8 hours. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 hours. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% vs 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) vs slow arms (35.2%). </p> <h4>CONCLUSIONS AND RELEVANCE: In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and PCO₂ than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis. </h4>

Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis

<b>IMPORTANCE: </b>Fluid replacement to correct dehydration, acidosis and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA) but little is known about optimal fluid infusion rates and electrolyte content. <p><b>OBJECTIVE</b><b>: </b><a>To</a> evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. </p> <p><b>DESIGN, SETTING, PaRTICIPANTS:</b><b> </b> The current analysis involved moderate or severe DKA episodes (n=714) in children <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial.</p> <p><b>INTERVENTION:</b> Children were assigned to one of four treatment groups using a 2-by-2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration). </p> <p><b>Results: </b>The rate of change of pH did not differ by treatment arm, but PCO₂increased more rapidly in the fast vs slow fluid infusion arms during the initial 4 hours of treatment. The anion gap also decreased more rapidly in the fast vs slow infusion arms during the initial 4 and 8 hours. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 hours. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% vs 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) vs slow arms (35.2%). </p> <h4>CONCLUSIONS AND RELEVANCE: In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and PCO₂ than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis. </h4>

Prepartum anionic diet induces hyperchloremic acidosis in high-producing dairy cows without preventing subclinical hypocalcemia

ABSTRACT: In this study we evaluated the effects of the prepartum anionic diet on the electrolyte balance and calcemia of high producing dairy cows in the first days of lactation, and investigated the impact on the frequency of subclinical hypocalcemia (SCH). Sixty healthy Holstein cows, producing 30 kg of milk/day, handled in intensive system (compost barn), were distributed in groups (n=15) according to lactation order: first, second, third, and fourth to sixth. In the last three weeks before calving they received a diet with negative DCAD (-6mEq/100g DM) and high chloride content. After calving, they received a diet with positive DCAD (18mEq/100g DM). Urine pH was measured before calving. Serum Na+, Cl-, K+, and total Ca concentrations, and the strong ion difference (SID3) were determined in samples taken soon after calving (0h), 24, 48, 72 and 96h after. The frequencies of SCH were determined considering the critical value of 2.125mmol/L (8.5mg/dL). Two-way repeated measures ANOVA and chi-square test were used for comparisons. The cows eliminated acidic urine before calving. Na+, K+, Cl-, and SID3 values did not differ between groups. Na+ and K+ did not vary between days; Cl- was elevated at calving and decreased until 72h; and SID3 was reduced at calving and increased up to 48h. The Ca levels were reduced until 24h and increased up to 72h. Cows of third and fourth to sixth lactations presented lower values up to 24h. SCH was observed in almost half of the cows (43.3% to 55%) until 48h. The maintenance of hypocalcemia for three or more consecutive days occurred in 53.3% of third and fourth to sixth lactations cows. Ingestion of a high chloride prepartum anionic diet led to hyperchloremic acidosis and this imbalance was reversed on the second postpartum day. The induced effects on electrolyte and acid-base balances were not able to prevent the occurrence of SCH in the first days of lactation.

Experimental protocol for metabolic acidosis induction by intravenous administration of hydrochloric acid in sheep

ABSTRACT The aim of this study was to assess the magnitude and duration of blood and urine changes and the side effects of hyperchloremic acidosis induced by the intravenous administration of hydrochloric acid in sheep. Five healthy, crossbred adult ewes, with a mean body weight of 44±2.9kg were used. The hydrochloric acid solution was administered intravenously at a rate of 25mL/kg/h for 4 hours continuously. Venous blood and urine samples were collected and pH values, blood carbon dioxide partial pressure, bicarbonate, base excess, strong ion difference, anion gap, total concentration of nonvolatile buffers, creatinine, plasma L-lactate, plasma and urine sodium, potassium, and chloride were determined. The experimental protocol induced severe hyperchloremic acidosis at the end of the infusion, with a decreased plasma strong ion difference. The fractional excretion of sodium and chloride remained increased during 4 hours after the infusion. Aciduria was observed at approximately 24 hours. Twenty-four hours after the infusion, the animals showed mild and compensated metabolic acidosis. This protocol was effective in inducing severe and long-lasting hyperchloremic acidosis and did not cause serious side effects. Therefore, this protocol can be used safely in adult sheep for studies on the treatment of this condition.