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Abstract Objective: This study aimed to describe the effect of the use of 0.9% saline (NS) versus 0.45% saline (half NS) during fluid management of diabetic ketoacidosis (DKA) in children. Methods: This was a prospective, randomized, non blinded study that included 121 patients with moderate and severe diabetic ketoacidosis admitted in the Diabetes, Endocrinology & Metabolic Pediatric Unit (DEMPU) at Cairo University Children`s Hospital from April 2016 to April 2017. Results: The incidence of hyperchloremic acidosis was significantly less with the use of half normal saline compared to normal saline during the management of DKA (P value = 0.02) without adversely affecting other outcomes. Conclusions: Hyperchloremic acidosis can occur during management of DKA in patients receiving NS as post-bolus rehydration fluid. Alternatively, the use of half NS may result in a decrease in the incidence of hyperchloremic acidosis |