Paeds Cases · nephrology-urology-fluids-and-electrolytes
Acid-base disorders in children — OSCE
OSCE communication and clinical reasoning station for the parents of a child newly diagnosed with type 1 diabetes presenting in diabetic ketoacidosis, covering the blood gas interpretation in plain terms, the DKA management, the role of bicarbonate and why it is not used, and the safety-net and sick-day rules for the future.
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You are the paediatric registrar. The patient is 8 and was admitted overnight in diabetic ketoacidosis, his first presentation of type 1 diabetes. He is now on the DKA protocol with fluids and an insulin infusion, his pH is improving and his breathing has settled. His parents are anxious and have asked why his breathing was so deep, why a blood test was being done so often, and whether a medicine to neutralise the acid should be given. Explain clearly what the blood gas showed and what it means, what the treatment is doing, why no bicarbonate is being given, and agree a safety-net and a forward plan for diabetes education. [1]
References5ShowHide
- [1]Berend K; de Vries AP; Gans RO Physiological approach to assessment of acid-base disturbances. N Engl J Med, 2014.PMID 25295502
- [3]Kraut JA; Madias NE Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol, 2010.PMID 20308999
- [5]Dhatariya KK; Glaser NS; Codner E; Umpierrez GE Diabetic ketoacidosis. Nat Rev Dis Primers, 2020.PMID 32409703
- [6]Calimag APP; Chlebek S; Lerma EV Diabetic Ketoacidosis. Disease-a-Month, 2023.PMID 35577617
- [10]Wilson RF; Spencer AR; Tyburski JG; Dolman H Bicarbonate therapy in severely acidotic trauma patients increases mortality. J Trauma Acute Care Surg, 2013.PMID 23271076