A Consequence of Fluid Therapy Algorithm of Diabetic Ketoacidosis: Iatrogenic Hyperchloremic Acidosis.

Introduction: Since the aim of fluid therapy in diabetic ketoacidosis (DKA) is to remove ß-hydroxybutyrate with Na from the kidneys, the first recommended fluid is 0.9% NaCl. BECl (Na-Cl-32) is the best chloride evaluation. Administering fluids with BECl <32 in DKA may cause hyperchloremic acidosis. This study investigates the effect of the administered fluids with BECl <32 and BECl ≥32 on metabolic acid-base status in the first 6 hours of DKA. Materials and Methods: Patients with DKA admitted to intensive care units (ICU) in the last 15 years were retrospectively evaluated. Demographic data, blood gas samples, and strong ion gap (SIG) were recorded at the ICU admission and the 6th hour. According to BECl values of administered fluids in the first 6 hours, patients were separated into two groups: Group I (Fluids with BECl<32) and group II (fluids with BECl ≥32). SPSS Version 28 was used for statistical analysis. Results: DKA was detected in forty-seven (0.2%) of 15,364 patients. Thirty-two (GI=26; GII=6) patients with DKA were included in the study. Demographics and blood gas parameters at the ICU admission and SIG, Na, K, lactate, and glucose levels at the 6th hour were similar in groups. At the 6th hour, pH, PaCO₂, HCO₃, SBE, and Na-Cl difference in GI were significantly lower (p<0.001, p=0.016, p=0.011, p=0.022 and p<0.001, respectively), whereas Cl was significantly higher than GII (p=0.023). Conclusion: Although SIG is decreased by administering fluids with BECl <32 in DKA, the reason for the lack of expected increase in HCO₃ and SBE and continued hypocapnia at the 6th hour is the iatrogenic hyperchloremia. Hence, the usage of fluids with BECl <32 in DKA should be avoided, and the fluid therapy algorithm of DKA should be reconsidered. [ABSTRACT FROM AUTHOR]