Sat13November1123AM 9

A 6-year-old is admitted unconscious. His breath smells of acetone.

Blood gas estimation is:

pH 7.05 (7.36-7.44)

pCO2 24 mmHg (35-45)

Standard bicarbonate 12 mmol/L (20-28)

Blood glucose 47 mmol/L (3.0-6.0)

Which of the following may be expected?

True / False

Is likely to have a raised blood urea Correct

Treatment with insulin should be commenced immedietly Incorrect answer selected

He has a respiratory acidosis Correct

Large volumes of 0.9% sodium chloride IV are contraindicated because of the risk of precipitating cardiac failure Correct

He has a metabolic acidosis Correct

Explanation

pCO2 and serum bicarbonate are low and this is consistent with metabolic acidosis and respiratory compensation.

In respiratory acidosis the PCO2 would be high and bicarbonate levels would be higher to effect a 'metabolic compensation'.

In view of the fact that he has diabetic ketoacidosis, treatment with insulin should be commenced. However, it is best practice to wait one hour after initialy rehydration has commenced.

As a result of osmotic diuresis and natriuresis mediated by glucose he will be dehydrated and sodium depleted. This will raise blood urea.

Volume replacement with 0.9% saline must be adequate, however over vigorous rehydration could precipitate cerebral oedema.

Answer Statistics

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Average score: 82.24%

Times answered: 268