Diabetic Ketoacidosis

Ominous

Step 1: View clinicals

A 4 year old girl presents with mild abdominal pain and vomiting since last night. There is no history of fever, diarrhea, or urinary symptoms. Her parents mention that she lost some weight during the previous month, despite a good appetite. Her medical, family and birth histories are unremarkable.


Step 2: Order all relevant investigations

Full Blood Count

WBC: 11,000/mm3 N 70%, L 25% Hb: 13 g/dL Hct: 40% Platelets: 350,000/mm3

Capillary Blood Glucose

Her capillary glucose level is 720 mg/dl A blood ketone level is performed and is found to be 4 mmol/l (normal: < 0.6 mmol/l)

Renal profile

Urea: 13 mg/dl (7 - 20 mg/dl) Creatinine: 0.6 mg/dl (0.2 - 1 mg/dl) Na+ 140 mmol/l (135 - 145 mmol/l) K+ 3.9 mmol/l (3.5 - 5 mmol/l) Cl- 99 mmol/l (98 - 108 mmol/l)

Venous blood gases

pH: 7.25 PCO2 : 45 mmHg PO2 : 60 mmHg HCO3: 10.3 mmol/l Base excess: -15.0 mmol/l


Step 3: Select appropriate management

Nil orally
IV 0.9% saline bolus
IV insulin bolus
IV Sodium Bicarbonate


Score: ★★☆