Document Type

Final Project

Graduation Date

Spring 5-6-2023

Degree Name

Doctor of Nursing Practice

First Advisor

Peggy Pelish



Complications of diabetic ketoacidosis (DKA) include iatrogenic hyperchloremia and acute kidney injury (AKI). The objective of this study was to evaluate the association of decreasing sodium chloride (NaCl) composition in standard DKA fluid resuscitation and the rates/severity of hyperchloremia and AKI in pediatric patients.


In December 2020, Children’s Hospital and Medical Center (CH&MC) changed the standard base composition of DKA fluids from 0.9% to 0.675% sodium chloride (NaCl) and increased the fluid resuscitation rate for patients over 30kg as a quality improvement project. A retrospective chart review analyzed patients admitted with DKA from January 2019-December 2021, excluding patients


There were 345 patients included in the study, 183 in the baseline group (0.9% NaCl) and 162 in the intervention group (0.675% NaCl). No differences in severity of acidosis based on pH, bicarbonate, or GCS scores were noted between groups. No difference in rates of hyperchloremia between the intervention and baseline groups were observed (144 [79%] vs. 122 [75%], p=0.52). Rates of AKI (28 [16%] vs. 18 [11%], p=0.34), hospital LOS (hours) (51.2 vs. 55.0, p=0.35), and insulin drip duration (minutes) (825.0 vs. 852.0, p=0.67) were reported.


In pediatric patients with DKA, decreasing NaCl concentrations to 0.675% does not appear to play a significant role in the reduction of hyperchloremia and AKI when compared to 0.9% NaCl concentrations. Increased fluid resuscitation rates may have impacted the total chloride delivered to the patient despite decreasing the NaCl composition.