الفهرس 
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Abstract
DKA is characterized by hyperglycemia, formation of keton bodies, and increased anion gap metabolic acidosis. Volume depletion along with electrolyte disturbances associates these derangements.
Children with DKA experience various degrees of dehydration and electrolyte disturbances because of osmotic diuresis. Persistent polyuria is considered the commonest symptom in children with DKA and may result in severe dehydration.
Treatment of DKA includes volume resuscitation, insulin, in addition to correcting the electrolyte disturbances. Conventional volume resuscitation that utilizes saline causes worsening of electrolyte disturbances in DKA patients, in particular the development of hyperchloremia that accompanying elevated risk of morbidity& mortality.
This study aims to assess the relation between hyperchloremia and development of DKA & Its influences on clinical outcomes.
It was a cross sectional study that was carried on 70 children between 1-13 years old in pediatric endocrinology unit in Beni-Suef university hospital in which all patients were subjected to detailed medical history obtained from their parents and full clinical examination . Investigations included were daily Na, K, Urea, Cr, CL, ABG and Albumin Cr ratio, after approval of internal ethical committee.
The main Result of the study revealed that:
51.4% of the patients were female and 48.6 were male.
Family history of DKA was found in 28.6% of patients.
85.7% of the patients had a new onset DM presenting as DKA.
Out of 70 patients; 49 developed hyperchloremia.
Patients with hyperchloremia had longer times to final DKA resolution in comparison with those with normochloremia.
In our study AKI was documented in 48 (86.6%) of our patients; 28 (58.3%) of them had pRIFLE 1, 18 (37.5%) pRIFLE 2 and 2 (4.2%) had pRIFLE 3 at admission.
In conclusion : The development of hyperchloremia in patients with DKA was accompanied by worse clinical outcomes such as increased time to DKA resolution, hospital LOS, and development of in-hospital AKI.