Editing Diabetic ketoacidosis (section)

===Fluid replacement===
The amount of fluid replaced depends on the estimated degree of dehydration. If dehydration is so severe as to cause [[Shock (circulatory)|shock]] (severely decreased [[blood pressure]] with insufficient blood supply to the body's organs), or a depressed level of consciousness, rapid infusion of [[saline (medicine)|saline]] (1&nbsp;liter for adults, 10&nbsp;mL/kg in repeated doses for children) is recommended to restore circulating volume.<ref name=ADA2009/><ref name=BSPED>{{cite web | vauthors = Edge J | title=BSPED Recommended DKA Guidelines 2009 | publisher=British Society for Paediatric Endocrinology and Diabetes | date=May 2009 | url=https://www.bsped.org.uk/professional/guidelines/docs/DKAGuideline.pdf | access-date=2009-07-12 | url-status=dead | archive-url=https://web.archive.org/web/20111027082817/http://www.bsped.org.uk/professional/guidelines/docs/DKAGuideline.pdf | archive-date=2011-10-27 }}</ref> Slower rehydration based on calculated water and sodium shortage may be possible if the dehydration is moderate, and again saline is the recommended fluid.<ref name=NICE2015>{{cite web|title=Type 1 diabetes in adults: diagnosis and management|url=http://www.nice.org.uk/guidance/ng17|publisher=National Institute for Health and Care Excellence|access-date=10 February 2016|date=August 2015|url-status=live|archive-url=https://web.archive.org/web/20160809065421/https://www.nice.org.uk/guidance/NG17|archive-date=9 August 2016}}</ref><ref name=BSPED/> Very mild ketoacidosis with no associated vomiting and mild dehydration may be treated with oral rehydration and subcutaneous rather than intravenous insulin under observation for signs of deterioration.<ref name=BSPED/>

[[Normal saline]] (0.9% saline) has generally been the fluid of choice.<ref name=Jay2019>{{cite journal | vauthors = Jayashree M, Williams V, Iyer R | title = Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives | journal =  Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy| volume = 12 | pages = 2355–2361 | date = 2019 | pmid = 31814748 | pmc = 6858801 | doi = 10.2147/DMSO.S194944 | doi-access = free }}</ref> There have been a few small trials looking at balanced fluids with few differences.<ref name=Jay2019/>

A special but unusual consideration is [[cardiogenic shock]], where the blood pressure is decreased not due to dehydration but due to the inability of the heart to pump blood through the blood vessels. This situation requires ICU admission, monitoring of the [[central venous pressure]] (which requires the insertion of a [[central venous catheter]] in a large upper body vein), and the administration of [[inotrope|medication that increases the heart pumping action]] and blood pressure.<ref name=ADA2009/>