Acid-base disorders in children — viva

Opening (must-hit)

"This child has a severe high anion gap metabolic acidosis from diabetic ketoacidosis, and he is compensating appropriately with his breathing. I work through the gas systematically: the pH of 7.12 is acidemia; the bicarbonate of 6 is low and the pCO2 is low, so the primary process is a metabolic acidosis; the anion gap of 28 is high, confirming acid gain; the Winters expected pCO2 is 1.5 times 6 plus 8, equal to 17, with a range of 15 to 19, and his measured 18 falls within that range, so the respiratory compensation is appropriate and there is no coexisting respiratory disorder. The picture with hyperglycaemia and ketones is DKA. My immediate management is structured fluid resuscitation, then a fixed-rate insulin infusion once I know the potassium, careful potassium replacement, and monitoring for cerebral oedema. I would not give bicarbonate here." [1][5]