Paeds Cases · endocrinology-diabetes-and-growth
New-onset DKA in a district hospital — OSCE
OSCE clinical management and communication station: managing new-onset diabetic ketoacidosis in a child at a district hospital before retrieval, delivering the ISPAD fluid, insulin and potassium plan, monitoring for cerebral oedema, and explaining the new diagnosis of diabetes to a frightened family.
On this page
Study tools
Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
You are the paediatric registrar at a regional hospital. A 9-year-old girl, previously well, is brought in by her parents with a two-week history of thirst, frequent urination and weight loss, now vomiting, tired and breathing heavily. Her capillary glucose reads 'HI', blood ketones are 6.1 mmol/L, and a venous gas shows pH 7.12 with a bicarbonate of 8 mmol/L. She is alert but clearly dehydrated, and she is not shocked. The nearest paediatric intensive care unit is two hours away by road. Manage her initial care, decide on retrieval, and explain to her parents what is happening.
Task
You have twelve minutes. Confirm the diagnosis and severity, begin the ISPAD-aligned management appropriate to a district hospital, decide about retrieval, set up the monitoring that will catch deterioration, and explain the situation to the parents with clarity and compassion. The examiner will assess both your clinical plan and your communication. [1]
References4ShowHide
- [1]Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state Pediatr Diabetes, 2022.PMID 36250645
- [3]Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics N Engl J Med, 2001.PMID 11172153
- [8]Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state Pediatr Diabetes, 2018.PMID 29900641
- [9]Marcin JP, Glaser N, Barnett P, et al. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema J Pediatr, 2002.PMID 12461495