A) Normal saline
Normal saline has 154 meq/L of chloride, whereas, the others have 109, 98, and 111 meq/L respectively. If large volumes of normal saline are needed to rehydrate or resuscitate a patient, the patient may develop hyperchloremic non-anion gap metabolic acidosis as the excess chloride force bicarbonate intracellularly and impairs bicarbonate resorption in the kidneys. Sometimes this can be seen in the DKA patient given excessive normal saline – the anion gap acidosis from DKA is improving, but there is a persistent non-anion gap acidosis. This hyperchloremic non-anion gap acidosis is best treated with bicarbonate administration, something which is not generally recommended in the treatment of DKA.
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December 25, 2019 at 5:22 am
A) Normal saline
Normal saline has 154 meq/L of chloride, whereas, the others have 109, 98, and 111 meq/L respectively. If large volumes of normal saline are needed to rehydrate or resuscitate a patient, the patient may develop hyperchloremic non-anion gap metabolic acidosis as the excess chloride force bicarbonate intracellularly and impairs bicarbonate resorption in the kidneys. Sometimes this can be seen in the DKA patient given excessive normal saline – the anion gap acidosis from DKA is improving, but there is a persistent non-anion gap acidosis. This hyperchloremic non-anion gap acidosis is best treated with bicarbonate administration, something which is not generally recommended in the treatment of DKA.