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DKA Before Emergency Surgery Child — FRCA Final MCQ

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HardPaediatric AnaesthesiaDKA Before Emergency Surgery ChildFRCA Final

A 10-year-old child (32 kg) with type 1 diabetes on an insulin pump is listed for appendicectomy. His blood glucose is 18 mmol/L and blood ketones 3.5 mmol/L. pH is 7.25. What is the immediate priority before proceeding to surgery?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Increase the insulin pump rate and proceed

This child has diabetic ketoacidosis (hyperglycaemia, ketonaemia >3, acidosis pH <7.3). DKA is a medical emergency that MUST be treated before elective procedures and should be stabilised before emergency surgery if possible. Treatment: IV 0.9% NaCl (10 mL/kg bolus if shocked, then maintenance), fixed-rate insulin infusion (0.05-0.1 units/kg/hr – DISCONNECT the insulin pump), potassium replacement guided by levels, and monitor glucose/ketones hourly. Surgery should proceed once: pH >7.3, ketones <1, glucose improving, and the patient is haemodynamically stable. Close liaison between anaesthetist, surgeon, and diabetes team is essential.

Reference: JBDS – 2022 – DKA management in children; NICE – 2020 – NG18 Diabetes in children