Question 03

In an adolescent with DKA who is shocked, which of the following fluids would be the most appropriate for initial resuscitation?

0.45% NaCl 10ml/kg bolus
0.45% NaCl plus 5U insulin bolus
0.9% NaCl 10ml/kg bolus
0.9% NaCl plus 20mmolKCl bolus
0.9% NaCl plus 5U insulin bolus
Check answer

Explanation

In an adolescent with DKA requiring resuscitation the appropriate fluid is 0.9% NaCl 10ml/kg, repeated if necessary. Potassium should only be added to the rehydration fluids once resuscitation is complete and assuming normal renal function. An insulin infusion will be started too.

Question 04

Which of the following is a typical biochemical profile in DKA?
Glucose >11mmol, pH > 7.45, Bicarb <15 mmol
Glucose >11mmol, pH < 7.25, Bicarb >25 mmol
Glucose >11mmol, pH <7.25, Bicarb <15 mmol
Glucose <11mmol, pH > 7.45, Bicarb <15 mmol
Glucose >11mmol, pH ,< 7.45, Bicarb >25 mmol
Check answer

Explanation

A typical profile would include raised glucose, low pH and low bicarbonate, and also ketonuria.

Question 05

What combination of initial investigations would be most appropriate?

Blood glucose, EUC venous gas, ammonia
Blood glucose, EUC, venous gas, amylase
Blood glucose, EUC, arterial gas, FBC
Blood glucose, EUC, venous gas, FBC
Blood glucose EUC, venous gas, beta hCG,
Check answer

Explanation

Initial essential investigations would include blood glucose, EUC, venous gas, FBC plus urinalysis for the presence of ketones. Of course other investigations may be required, depending on the clinical presentation, but those listed can be ordered for urgent analysis and most will be available within a short time frame to aid in management decisions.

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