Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis

To the Editor: In their report on the Pediatric Emergency Care Applied Research Network trial of fluid infusion rates in patients with diabetic ketoacidosis (PECARN DKA FLUID), Kuppermann et al. (June 14 issue) 1 do not provide data on whether there was a correlation between a decrease in the effective plasma osmolality and deterioration in the Glasgow Coma Scale score or clinically apparent brain injury. Observational data and physiological analyses of the factors that may contribute to development of cerebral edema suggest that a rapid decline in plasma effective osmolality (two times the plasma sodium concentration plus the plasma glucose concentration) . . .