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Cerebral Oedema in DKA — RACP Adult Medicine MCQ

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HardEndocrinologyCerebral Oedema in DKARACP Adult Medicine

A 18-year-old man with DKA has been receiving IV fluids and insulin. He initially improves but then develops headache, confusion, and vomiting 8 hours into treatment. His blood glucose has dropped rapidly from 35 to 8 mmol/L. Na⁺ has fallen from 148 to 132 mmol/L. What is the most likely complication?

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Correct answer: A — Cerebral oedema

Headache, confusion, and vomiting during DKA treatment with rapid glucose decline and falling sodium is cerebral oedema. Risk factors include: rapid fluid administration, excessive glucose decline (>5.5 mmol/L/hr), young age, and severe DKA. Prevention: avoid overly aggressive fluid resuscitation, do not exceed glucose decline of 3–5 mmol/L/hr, and use 0.9% NaCl (not hypotonic solutions). Treatment is IV mannitol or hypertonic saline.

Reference: ADS – 2024 – DKA; JBDS-IP 2024 DKA Guidelines