4.5 D) Diabetic Ketoacidosis Paediatric

Front 1

(Paediatric Emergency medicine Secrets-EMS)
What are the key issues in treating Paediatric DKA?

Back 1

1. Fluid replacement
2. Acidosis correction
3. Glucose and electrolyte adjustment

Front 2

(EMS)
Which of the following is incorrect regarding

Paediatric DKA?
A. Cerebral oedema is the main cause of death in DKA.
B. Cerebral oedema has a 25% mortality rate.
C.The degree of DKA is not dependent on the extent of hyperglycaemia- it is related more to the pH and bicarbonate.
D. Insulin underutilisation is the usual factor leading to DKA.

Back 2

B. Mortality rate for Cerebral oedema : 60-80%

Front 3

(RCH)
What re the 3 main blood findings in Paediatric DKA?

Back 3

Hyperglycaemia +
Metabolic acidosis +
Ketonaemia

Front 4

(RCH)
What are the biochemical criteria for DKA?

Back 4

1. Hyperglycaemia > 11.1
2. Ketonaemia > 0.6
3. venous pH < 7.3
4. Bicarbonate < 15 mmol/L

Front 5

(RCH)
What is a positive ketone level ?

Back 5

> 0.6 mmol/L

Front 6

(RCH)
In regards to the fluid and electrolyte replacements guidelines for DKA, which of the following is correct?
A. As the blood glucose level falls, so does the corrected sodium.
B. Fluid boluses > 20ml/kg are commonly required for moderate - severe dehydration in DKA.
C. Rehydration is commenced with 0.9% saline.
D. Once the BSL reaches 12-15 mmol/L during treatment, the fluid is changed to 0.9% saline with 5% dextrose and potassium.

Back 6

D.

A= correct sodium remains stable / rises with falling BSL
B= DKA Rarely requires > 20mL/kg fluid boluses
C = rehydrate with 0.9% saline PLUS potassium

Front 7

(RCH)
Beyond the initial 6 hours of fluid rehydration, what are the indications for continuuing 0.9% saline + 5% dextrose + potassium, RATHER THAN changing to 0.45% saline + 5% dextrose and potassium?

Back 7

1. Hyponatraemia present
2. Corrected sodium fails to stabilise as BSL decreases.
3. Correct sodium fails to rise as BSL decreases.
4. Patient is hyperosmolar ( with concern for rapid shifts in osmolality)

Front 8

(RCH)
In regards to potassium in DKA, which of the following is incorrect?
A. Patients may present with hyper, hypo or normokalaemia in DKA.
B. Correction of the acidosis , without potassium therapy, will result in hypokalaemia.
C. Potassium therapy is initially deferred if the K+ > 5mmol/L
D. The usual starting KCL concentration replacement is 40-60mmol/l , depending on weight ( < or > 30kg).

Back 8

C. Potassium therapy is witheld if K+ > 5.5 mol/L

Front 9

(RCH)
Which is incorrect regarding Paediatric DKA?
A.Insulin is used until the ketones are cleared, and the acidosis is corrected.
B. The aims for BSL during treatment is 5 -12mmol/L
C. Continuing metabolic acidosis indicates insufficient fluid replacement + insulin replacement.
D. Bicarbonate should never be given in Paediatric DKA.

Back 9

D. It is given in RARE circumstances:
- pH < 7.0
+/- HCO3 < 5 mmol/L
+ adrenaline requiring for hypotension
+ marked hyperkalaemia

Front 10

(RCH)
Which of the following is incorrect regarding Paediatric DKA?
A. Measured sodium is depressed by the dilutional effect of hyperglycaemia : " Hypertonic Hyponatraemia"
B. Corrected Sodium = Measured Na + Glucose -5 / 4
C. For every 5 mmol/L of glucose above 5.5 mmol/L , there is a rise of sodium of 3 mmol/L.
D. If sodium does not rise as the glucose falls, it usually indicates excessive volume correction.

Back 10

C. "Corrected Sodium" : For every 10mmol/L rise in glucose above 5.5 mol/L, there is a rise of sodium of 3 mmol/L.

Front 11

(Rch)
In regards to cerebral oedema in DKA, which of the following is incorrect?
A. It can occur suddenly.
B. There is some degree of 'subclinical' brain swelling present during most episodes of DKA.
C. The rate of correction of blood glucose should not exceed 5 mmol/L per hour.
D. Cerebral oedema usually occurs after 12 hours of therapy.

Back 11

D. It can start as early as 2 hours, but usually occurs between 6 to 12 hours after starting therapy.

Front 12

(RCH)
in regards to Paediatric DKA and cerebral oedema, which of the following is incorrect?
A. Patients should be Nursed head up ( 30 degrees)
B. Risk factors include age (Adolescence) and first presentation.
C. Clinical signs include headache, irritability and incontinence.
D. Treatment is with 0.5 g/kg 20% mannitol IV over 20 minutes.

Back 12

B.
1. Age < 5 yrs
2. First presentation
3. Long History of poor control.

Front 13

(RCH)
Which of the following is incorrect regarding Paediatric DKA ?
A. Patients with ketosis but normal pH, with an insulin pump, should have the pump re-sited and be given 20% of their daily rapid acting insulin s/c.
B. ANGEL cream can be used for initial dosing of insulin in a newly diagnosed child.
C. The degree of dehydration in DKA is usually under-estimated.
D. ECG should be performed to look for hyper /hypo -kalaemia.

Back 13

C. the degree of dehydration is usually over-estimated.