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Diabetic Ketoacidosis — RACP Paediatrics MCQ

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HardEndocrinologyDiabetic KetoacidosisRACP Paediatrics

A 10-year-old boy in DKA has a blood glucose of 25 mmol/L, pH 7.1, and serum sodium of 130 mmol/L. His corrected sodium is calculated at 136 mmol/L. After 4 hours of treatment, his blood glucose falls to 15 mmol/L but the corrected sodium drops to 132 mmol/L. What does the falling corrected sodium indicate?

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Correct answer: B — Risk of cerebral oedema

In DKA, corrected sodium should rise as blood glucose falls during treatment. A falling corrected sodium during DKA treatment is a warning sign for cerebral oedema/injury, indicating excessive free water accumulation in the intravascular space. Clinical monitoring for signs of cerebral oedema (headache, altered consciousness, bradycardia, hypertension) should be intensified.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Diabetic Ketoacidosis