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Type 1 diabetes nocturnal hypoglycemia — USMLE Step 3 MCQ

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HardPediatricsType 1 diabetes nocturnal hypoglycemiaUSMLE Step 3

A 10-year-old receiving treatment for DKA develops severe headache, bradycardia, declining consciousness and oxygen desaturation. What should be done immediately?

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Correct answer: B — Give hypertonic saline or mannitol immediately and adjust ongoing DKA fluid therapy

The best answer is “Give hypertonic saline or mannitol immediately and adjust ongoing DKA fluid therapy”. The neurologic deterioration during DKA treatment is cerebral injury until proved otherwise. Hyperosmolar therapy is given immediately and fluids are adjusted with critical-care support; CT can follow stabilization. Insulin boluses, complete fluid cessation and bicarbonate do not treat the intracranial emergency.

Reference: ADA Standards of Care in Diabetes—Children and Adolescents: https://diabetesjournals.org/care/article/49/Supplement_1/S283/163920/14-Children-and-Adolescents-Standards-of-Care-in