MedBugs: SAQ #32

Case: DKA

A 10-year-old girl has presented to your urban district emergency department at 3pm with fever and feeling lethargic for the past week, vomiting 3 x today. The child is unable to tolerate oral intake. On examination :

Weight 40kg
HR 150
BP 100/80
RR 40
Sats 100% RA
Temp 38.5
GCS 15
Central CR 4 seconds
BSL 23
S. ketones 6

1. State (3) assessment variables, including cut-offs, that help stratify and indicate sever to life-threatening DKA 3 marks

You get the following blood results from cannulating the patient:

pH	7.2	(7.35–7.45)
pCO₂	28	(40–50 mmHg)
HCO₃	8	(24–26 mmol/L)
Lactate	2.0	(0.6–2.4 mmol/L)
Na⁺	128	(135–145 mmol/L)
K⁺	4.5	(3.5–5.5 mmol/L)
Cl⁻	100	(95–110 mmol/L)
iCal	1.22	(1.13–1.33 mmol/L)
Glucose	23
Urea	10	(2.0–6.8 mmol/L)
Creatinine	70	(27–58 micromol/L)

2. Demonstrate the calculation for the patient’s corrected serum Na 1 mark

3. Demonstrate the calculation for the patient’s anion gap. 1 mark

4. Demonstrate the calculation for the patient’s serum osmolality. 1 mark

Atier many hours in the ED, the patient is still awaiting transfer to a tertiary Paediatric Hospital. Towards the end of your evening shift, you are called to atend as the patient’s GCS has dropped from 14 to 9

5. State the likely cause and your management priorities 6 marks

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