Remember to keep track of net fluid needs, which means the total fluid deficit as well as ongoing urine and insensible losses. In addition to improving tissue perfusion, fluid therapy lowers the hyperglycemia by dilution and increased glomerular filtration rate. A significant decrease in serum glucose can be achieved in the absence of any insulin therapy, simply by adequate hydration. There are several recommendations for the amount of fluid, type of fluid, and over what time period the fluid should be given over. The use of normal saline is well established, and its use avoids rapid fall in extracellular osmolarity.
Lactated ringers has less chloride and some buffers from hyperchloremic, acidotic patients.
However, it contains potassium and must be used with care in patients with elevated potassium levels. Half-normal saline with two ampules of bicarbonate can be used for severe acidosis. As stated, the usual initial fluid recommendation is normal saline. Although the patients are in a state of hypertonic dehydration, the initial need is intravascular repletion, which is why normal saline or lactated ringers is initially recommended. This initial management should be guided by the patient s general condition and response, with more or less fluid as indicated.