patients with underlying neurological disorders or neurocognitive deficits which would affect either mental status testing during treatment or subsequent neurocognitive testing after recovery
patients who present with concomitant alcohol or drug use, head trauma, meningitis or other conditions which might affect neurological function
patients transferred to one of the participating emergency departments after initiation of DKA treatment other than one 10cc/kg intravenous bolus of 0.9% saline
patients who are known to be pregnant at time of ED evaluation
patients who have been enrolled in this study twice previously
patients for whom the treating physician believed a specific fluid and electrolyte regimen was warranted
patients for whom informed consent could not be obtained within 1 hour after completion of the initial fluid bolus, or within 2 hours from initiation of fluids, whichever is longer
Patients who have been receiving IV fluids at a maintenance rate or greater (defined by the 4-2-1 rule) for more than two hours; OR
Patients for whom it has been more than four hours since DKA therapy (IV fluids, IV bolus, or IV insulin) began; OR
Patients who have been given hyperosmolar therapy (i.e. mannitol or 3% normal saline) prior to or since arriving at one of the participating PECARN emergency departments; OR
Patients for whom the treating physician intends to immediately administer hyperosmolar therapy (i.e. mannitol or 3% normal saline); OR
Patients whose baseline GCS is 11 or less.
Clareo Health | Randomized Control Trial of Fluid Therapy for Pediatric Diabetic Ketoacidosis
