A 9-year-old with type 1 diabetes has vomiting and abdominal pain. Glucose is 32 mmol/L, pH 7.12, bicarbonate 8 mmol/L, potassium 5.4 mmol/L, and he

Question

A 9-year-old with type 1 diabetes has vomiting and abdominal pain. Glucose is 32 mmol/L, pH 7.12, bicarbonate 8 mmol/L, potassium 5.4 mmol/L, and he is clinically dehydrated but alert. What is the most appropriate initial management?

Accepted Answer

Isotonic fluid resuscitation and insulin infusion after initial fluids with potassium-guided replacement

Answer

Sodium bicarbonate for pH above 7.0 as routine treatment

Answer

Delay insulin until acidosis resolves

Answer

Subcutaneous rapid-acting insulin and discharge once glucose falls

Answer

Large hypotonic fluid boluses to rapidly correct dehydration

Paediatric diabetic ketoacidosis — RCPSC EM MCQ

A 9-year-old with type 1 diabetes has vomiting and abdominal pain. Glucose is 32 mmol/L, pH 7.12, bicarbonate 8 mmol/L, potassium 5.4 mmol/L, and he is clinically dehydrated but alert. What is the most appropriate initial management?