A 9-year-old with new diabetes has vomiting, Kussmaul breathing and drowsiness. Venous pH is 7.08, bicarbonate 6 mmol/L, glucose 29 mmol/L and

Question

A 9-year-old with new diabetes has vomiting, Kussmaul breathing and drowsiness. Venous pH is 7.08, bicarbonate 6 mmol/L, glucose 29 mmol/L and ketones are high. Potassium is 4.2 mmol/L. What is the most appropriate management?

Accepted Answer

Careful isotonic fluid replacement, insulin infusion and potassium monitoring

Answer

Large fluid boluses until glucose normalises

Answer

Subcutaneous rapid-acting insulin every hour

Answer

Immediate intravenous bicarbonate to correct acidosis

Answer

Delay insulin until ketones disappear

Diabetic ketoacidosis — RACP Paediatrics MCQ

A 9-year-old with new diabetes has vomiting, Kussmaul breathing and drowsiness. Venous pH is 7.08, bicarbonate 6 mmol/L, glucose 29 mmol/L and ketones are high. Potassium is 4.2 mmol/L. What is the most appropriate management?