Question

A 7-year-old boy presents with fever, lethargy and polyuria. Capillary blood glucose is 24 mmol/L, and venous blood gas shows pH 7.12, bicarbonate 9 mmol/L and ketonaemia. Which initial fluid management in the emergency department is most appropriate?

Accepted Answer

10-20 mL/kg isotonic saline bolus if shocked, then cautious replacement over 48 hours

Answer

Rapid 40 mL/kg normal saline bolus in the first hour regardless of perfusion

Answer

No fluids until insulin has started

Answer

Commence half-normal saline at maintenance plus 20% for 24 hours

Answer

Use hypotonic fluid bolus to correct hypernatraemia quickly

Practice question

A 7-year-old boy presents with fever, lethargy and polyuria. Capillary blood glucose is 24 mmol/L, and venous blood gas shows pH 7.12, bicarbonate 9 mmol/L and ketonaemia. Which initial fluid management in the emergency department is most appropriate?