When starting fluid therapy in HHS/DKA, what initial rate is recommended in the absence of cardiac dysfunction?

In the management of Hyperglycemic Hyperosmolar State (HHS) and Diabetic Ketoacidosis (DKA), initiating fluid therapy is crucial for correcting dehydration and improving hemodynamics. The recommended initial fluid replacement rate of 5-20 mL/kg/h is appropriate because it provides a balanced approach to rapidly rehydrating the patient while minimizing the risk of fluid overload, especially in cases where cardiac function is normal.

Starting at this rate allows for sufficient fluid volume to replenish extracellular fluid deficits and assists in the dilution of serum glucose and osmotic substances, facilitating a safer and more effective correction of hyperglycemia. Additionally, this range accommodates individual patient needs, recognizing that not all patients would respond identically to fluid resuscitation due to variations in their clinical status. Thus, the choice of 5-20 mL/kg/h is grounded in established clinical guidelines aimed at optimizing patient outcomes during critical care management.