New Study Examines Chloride Levels During Diabetic Ketoacidosis in Children

Researchers examined hospital records from 364 children (852 separate DKA episodes) treated for diabetic ketoacidosis between 2016 and 2022. They focused on tracking serum chloride—an electrolyte that becomes abnormally high during DKA—and how it related to kidney function during treatment.

DKA is a serious complication that occurs when the body produces too many ketones, making the blood too acidic. Children with new-onset or established type 1 diabetes can develop DKA and require hospitalization for careful management. This study looked at what happens to chloride levels and kidney markers as children recover.

Children in the study started with a median chloride level of 105 mEq/L, which is close to normal. During treatment, chloride levels rose to a median peak of 118 mEq/L—noticeably elevated. It took about 50 hours on average for chloride to return to normal range.

The study found that higher peak chloride levels during treatment were independently associated with creatinine-defined acute kidney injury (a marker of kidney function change). Children with these higher chloride levels also tended to stay in the hospital longer.

Interestingly, the IV fluids given during treatment affected how quickly chloride normalized. Additional boluses of normal saline were associated with a slower return to normal chloride levels.

Researchers also examined the relationship between initial disease severity and kidney markers. Beta-hydroxybutyrate—a ketone that indicates DKA severity—was positively correlated with serum creatinine (a kidney function marker) at the time of hospital admission. This suggests that more severe DKA at onset was linked to greater kidney stress at that moment.

This research adds to our understanding of what happens inside the body during DKA treatment. Chloride, an electrolyte that rises during DKA, appears to play a role in kidney function changes during hospitalization.

The findings suggest that how we treat DKA—specifically the fluids and volumes used—may influence electrolyte trajectories and kidney outcomes. This doesn't mean patients should avoid necessary treatment; rather, it highlights an area where clinicians may refine how they manage DKA to minimize complications.

More research is needed to understand the full clinical significance of these associations and whether different treatment strategies could improve outcomes.

Source: Hospital pediatrics. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.