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Cerebral oedema in DKA — MRCPCH FOP MCQ

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HardEmergency paediatricsCerebral oedema in DKAMRCPCH FOP

A 13-year-old girl is being treated for DKA. Four hours after starting fluids and insulin she develops headache, bradycardia, rising blood pressure and reduced conscious level. What is the most likely diagnosis?

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

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Correct answer: A — Cerebral oedema

Headache, bradycardia, hypertension and reduced consciousness during DKA treatment indicate cerebral oedema. Hypoglycaemia can reduce consciousness but does not typically cause Cushing physiology; glucose should still be checked immediately. Panic attack would not explain bradycardia and hypertension with reduced consciousness. The pearl is that neurological observations are a core part of DKA management.

Reference: BSPED DKA guideline; NICE NG18