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Diabetic ketoacidosis in adolescent — RACGP Fellowship MCQ

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HardEmergency presentations in general practiceDiabetic ketoacidosis in adolescentRACGP Fellowship

A 13-year-old with type 1 diabetes presents to a rural practice with vomiting, abdominal pain and drowsiness. Glucose is 22 mmol/L, blood ketones 4.1 mmol/L and respiratory rate 28/min. What should the GP do next?

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

Reveal the answer and explanation

Correct answer: E — Arrange urgent ambulance transfer for protocolised paediatric DKA treatment

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

A is correct. Marked ketonaemia, vomiting, tachypnoea and altered alertness indicate paediatric DKA requiring urgent hospital transfer, controlled fluid replacement, insulin, electrolyte monitoring and neurological observation. B attempts home management despite impaired consciousness and significant ketosis. C delays definitive treatment and cannot safely correct the metabolic emergency. D accelerates ketogenesis; basal insulin is not simply stopped because the child is unwell. E assumes infection without evidence and does not address DKA. The GP should provide immediate resuscitative support and communicate with retrieval services rather than improvise a hospital insulin infusion in the practice.

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