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New type 1 diabetes with DKA — MCCQE Part 1 MCQ

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HardNausea/VomitingNew type 1 diabetes with DKAMCCQE Part 1

A 10-year-old child has polyuria, weight loss, vomiting and deep breathing. Glucose is 28 mmol/L, venous pH is 7.18 and beta-hydroxybutyrate is elevated. Which management sequence is most appropriate?

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

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Correct answer: B — Give isotonic fluid first; start intravenous insulin after 1 hour only if potassium exceeds 3.0 mmol/L, with neurologic monitoring

The child has moderate DKA: hyperglycaemia and ketosis are accompanied by a pH of 7.18. Paediatric management begins with isotonic fluid and assessment of potassium and other electrolytes. Intravenous insulin is started only after the first hour of fluid therapy and only when potassium is above 3.0 mmol/L; an insulin bolus is not given. Glucose, electrolytes, corrected sodium and neurologic status require frequent monitoring because cerebral injury can occur. Routine bicarbonate can increase harm and is reserved for exceptional indications such as active cardiopulmonary resuscitation or symptomatic hyperkalaemia.

Reference: Canadian Paediatric Society, Current recommendations for management of paediatric diabetic ketoacidosis: https://cps.ca/en/documents/position/current-recommendations-for-management-of-paediatric-diabetic-ketoacidosis