We suggest a modified approach for fluid replacement in patients with ESRD, preferring a small bolus of 250 mL initially with reassessment after each infusion—particularly if no hypotensive, or just insulin therapy without fluids bolus.13 Intensive fluid resuscitation during the initial management of DKA usually results in some degree of correction of hyperglycemia due to forced osmotic diuresis. The gene discussed is INS; the disease is Hyperglycemia.