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Raised intracranial pressure in DKA — RACP Paediatrics MCQ

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HardEmergency paediatricsRaised intracranial pressure in DKARACP Paediatrics

A 10-year-old being treated for severe DKA becomes increasingly irritable with headache and falling heart rate. Blood glucose is decreasing gradually and sodium has failed to rise as expected. Pupils are unequal. What is the most appropriate management?

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Correct answer: E — Treat suspected cerebral injury with hyperosmolar therapy and urgent senior review

Neurological deterioration during DKA treatment is cerebral injury until proven otherwise and requires immediate hyperosmolar therapy and senior critical care involvement. CT should not delay treatment when clinical signs are evolving. Failure of sodium to rise during therapy is an additional warning sign.

Reference: RCH Diabetic ketoacidosis guideline; Australian paediatric diabetes guidance