Too Sweet

13yo girl

p/w lethargy

PMH:
T1DM

Hx
3/7 malaise, lethargy
Non-compliant with insulin
Vomiting today

o/e looks unwell
A: unremarkable,
B: tachypnoea, SaO2 100% ra clear chest
C: tachycardic. hypotensive, dry MM, cCRT 3
D: eyes to voice, temp 36, BSL ‘Hi’

pH 7.0
pCO2 22
pO2 34
Bic 5
BE -11

Na 123
Cl 86
K 6.7

Gluc 42
lact 4

Severe DKA
Pure HAGMA: lactate + ketones
Partial resp compensation
Corrected Na normal
Potassium appropriate for pH

1) Correct dehydration
- 10ml/kg fluid bolus to correct shock
- replace remaining volume deficit over 48hours
- monitor K & glucose & replace as needed
2) Reverse ketoacidosis
- insulin infusion
3) Treat precipitants and complications
- infective screen
- restart long acting insulin
- monotor for cerebral oedema

DKA