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Cerebral oedema in paediatric DKA — ACEM Fellowship MCQ

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HardPaediatric emergenciesCerebral oedema in paediatric DKAACEM Fellowship

An 11-year-old being treated for DKA develops headache, bradycardia and falling GCS. Sodium has not risen and glucose is 18 mmol/L. What is the most important immediate response?

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

Reveal the answer and explanation

Correct answer: D — Reduce fluid rate, give mannitol and call critical care

Explanation lettering: D = shown as C · C = shown as D

C is correct. These are signs of clinically significant cerebral injury during paediatric DKA. RCH guidance is to seek senior/critical-care help, reduce the fluid rate by one-third and give mannitol or 3% sodium chloride without waiting for imaging. A does not treat cerebral injury and bicarbonate is not routine. B can worsen cerebral oedema risk. D is unsuitable with falling consciousness. E delays time-critical treatment.

Reference: Royal Children’s Hospital Melbourne: Diabetic ketoacidosis: https://www.rch.org.au/clinicalguide/guideline_index/Diabetic_ketoacidosis/