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Paediatric diabetic ketoacidosis — CCFP MCQ

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HardPaediatrics and adolescentPaediatric diabetic ketoacidosisCCFP

A 12-year-old with diabetic ketoacidosis has pH 7.12, glucose 29 mmol/L and potassium 2.8 mmol/L. Initial isotonic fluid has started and circulation is restored. What should happen next?

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

Reveal the answer and explanation

Correct answer: E — Replace potassium and defer insulin until serum potassium exceeds 3.0 mmol/L

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

C is correct. Profound hypokalemia creates an arrhythmic risk that insulin would worsen; potassium is replaced with close monitoring before insulin infusion begins. D can cause fatal intracellular potassium shift. E is not routine at this pH and can worsen potassium and cerebral risk. A withholds necessary controlled rehydration. B is not an acute DKA regimen. Neurologic status, glucose, electrolytes and corrected sodium require frequent protocolized review.

Reference: Canadian Paediatric Society: Paediatric diabetic ketoacidosis: https://cps.ca/en/documents/position/current-recommendations-for-management-of-paediatric-diabetic-ketoacidosis