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.
Ongoing reassessment is critical.
When dehydration does not appear severe, rehydration rates one-half as fast as the above regimens have been studied with good results and less electrolyte disturbance. This may be considered in those patients who appear only minimally dehydrated. These include decreasing glucagon release from the pancreas and limiting glucagon s effect on the liver. This decreases gluconeogenesis and ketogenesis in the liver. Additionally, the insulin allows glucose uptake and utilization by peripheral tissues.