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DKA cerebral oedema — RACP Paediatrics MCQ

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HardEndocrineDKA cerebral oedemaRACP Paediatrics

Four hours after DKA treatment begins, an 11-year-old develops severe headache, irritability, bradycardia and a falling Glasgow Coma Scale. Pupils remain reactive. What should be done immediately?

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

Reveal the answer and explanation

Correct answer: E — Give 3% sodium chloride 3 mL/kg IV over 15 minutes before any neuroimaging

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as E

B is correct. These are clinical signs of DKA cerebral injury. RCH requires immediate treatment without waiting for imaging: 3% sodium chloride 3 mL/kg over 15 minutes is one accepted option (mannitol 20%, 0.5 g/kg over 20 minutes is another), alongside head elevation, fluid-rate reduction and urgent intensive-care support. C dangerously delays treatment. D gives a large isotonic bolus and incorrectly makes stopping insulin the primary response. E is not routine DKA cerebral-injury treatment. A can worsen cerebral injury. Neuroimaging is considered only after treatment has begun and the child is stabilised, particularly if an alternative intracranial diagnosis remains possible.

Reference: Royal Children’s Hospital Melbourne: Diabetic ketoacidosis: https://www.rch.org.au/clinicalguide/guideline_index/Diabetic_Ketoacidosis/