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A 17-year-old female is brought to the emergency room with lethargy and confusion. She is found to be dehydrated secondary to diabetic ketoacidosis. Laboratory results are hemoglobin 17.7 g/dL, WBC 17,000 cells/mm3, predominantly neutrophils, platelets 550,000 cells/mm3; Sodium 130 mEq/L, potassium 5.8 mEq/L, chloride 96 mEq/L, bicarbonate 9 mEq/L, BUN 60 mg/dL, creatinine 1.9 mg/dL, and glucose 605 mg/dL. Transaminases, bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase are all normal. Arterial blood gases on room air are pH 7.19, pCO2 26 mm Hg, PO2 100 mm Hg, and bicarbonate 10 mEq/L. Serum ketones are positive. What is the appropriate hydration fluid for this patient?

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