Solved by AI teacher · Biology

10-year-old child with type 1 DM is admitted with obtundation. On examination he has thready pulse, BP 70/50 mm Hg, temp 37 C, RR 24/ min with fruity odour of breath. Labs show Na = 130 meq/L, K 3.5 meq/L, pH 7.2, pC02

Concept: Diabetic Ketoacidosis (DKA)

Question

10-year-old child with type 1 DM is admitted with obtundation. On examination he has thready pulse, BP 70/50 mm Hg, temp 37 C, RR 24/ min with fruity odour of breath. Labs show Na = 130 meq/L, K 3.5 meq/L, pH 7.2, pC02 20 mm Hg and HCO3  5 meq/L. RBS  500 mg and ketones are 4+ in urine. Correct about first step in management is?
a. NS bolus
b.NS  KCL infusion over 1 hour
c. NS  KCL infusion over 1 hour and Regular insulin infusion till ketonemia resolves
d. NS  KCL infusion over 1 hour and Regular insulin subcutaneously

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Hint: Consider the immediate life-threatening issues presented by the patient's vital signs and overall condition.

Step-by-step solution

  1. 1

    Patient Presentation

    10-year-old with Type 1 DM, obtundation, thready pulse, BP 70/5070/50 mm Hg, fruity breath, RBS 500500 mg, ketones 4+4+.
  2. 2

    DKA Diagnosis

    High blood glucose, metabolic acidosis (pH 7.27.2, HCO3_3 55), and ketonuria confirm Diabetic Ketoacidosis (DKA).
  3. 3

    Priorities in DKA

    Immediate priorities are fluid resuscitation for shock, then insulin, and electrolyte correction.
  4. 4

    Fluid Resuscitation

    Thready pulse and low BP indicate hypovolemic shock. Initial management is rapid fluid bolus.
  5. 5

    Choice of Fluid

    Normal Saline (NS) is the initial fluid of choice for DKA resuscitation.
  6. 6

    First Step

    An NS bolus is the correct first step to stabilize hemodynamics.

Final answer

(a) NS bolus

Remember: Fluid resuscitation is the immediate priority in DKA with shock.

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Quick check · test yourself

A patient presents with severe dehydration, hypotension, and altered mental status due to DKA. Which of the following is the most critical initial intervention?

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