Intravenously administered sodium chloride does not neurologically affect children with diabetic ketoacidosis, according to a study published in the New England Journal of Medicine.

Nathan Kuppermann, MD, MPH, of the Departments of Emergency Medicine and Pediatrics at the University of California Davis School of Medicine, and associates performed a 13-center, randomized, controlled analysis to understand the influence of administration rates and sodium chloride content in intravenous fluids (IV) on neurologic events in pediatric diabetic ketoacidosis.

A total of 1255 pediatric participants were randomly placed into 1 of 4 treatment groups: 0.9% of 0.45% sodium chloride concentration and quick or slow administration rates.

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The main outcome studied was reduced mental status using the Glasgow Coma Scale scores: numbers ranging 3 to 5. Scores below 14 indicated a worsening mental status; worsening outcomes were associated with lower numerical scores.

The secondary outcomes were clinically visible brain injury and short-term memory during the study and memory and IQ 2 to 6 months after diabetic ketoacidosis recovery.

Of the cohort, 132 children had a second occurrence of diabetic ketoacidosis, 2 children had a third occurrence (1389 total occurrences); 48 of these occurrences resulted in Glasgow Coma Scale scores lower than 14 (3.5%). Brain injury was reported in 12 of the occurrences (0.9%).

The four groups did not significantly vary in magnitude, percentage of occurrences, or duration of time that the Glasgow Coma Scale was below 14 in accordance with results to short-term memory tests and brain injury during treatment. Results for memory and IQ scores during 2 to 6 months of recovery also insignificantly differed between the cohorts.

“Neither the rate of administration nor the sodium chloride content of intravenous fluids significantly influenced neurologic outcomes in children with diabetic ketoacidosis,” the authors concluded.


Kuppermann N, Ghetti S, Schunk JE, et al. PECARN DKA FLUID Study Group. Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis. N Engl J Med. 2018; 378:2275-2287