Endocrine emergencies: integrated approach — branching viva

Branch 1 — Recognising the hidden endocrine emergency

The examiner opens: which children in the emergency department should have a fingerstick glucose? The candidate cites ISPAD: DKA symptoms are non-specific, so consider a fingerstick glucose in all children with rapid breathing, or with vomiting and abdominal pain without diarrhoea. Emergency assessment then includes immediate glucose, ketones, electrolytes, blood gases and conscious level. ^[1]

The examiner asks for the definition of DKA. The candidate gives the three required criteria: glucose above 11 mmol/L, venous pH below 7.3 or bicarbonate below 18 mmol/L, and ketonaemia or ketonuria. ^[1]