Pediatrics
A 7-year-old presents to Emergency Department with vomiting and abdominal pain for 1 day.
The child has had history of polydipsia, polyuria and weight loss for the last 3 weeks. Examination reveals dehydration and hypoactivity (see lab results). Blood pressure 90/50 mmH, Heart rate 110 /min, Respiratory rate 24 /min, Temperature 38.6 °C, Oxygen saturation 95 %, Weight 23 kg. ABG shows pH 7.12, HCO3 5, Ketones +4, Glucose +4. Which of the following is the most likely diagnosis?
الشرح
Core Concept: Diabetic Ketoacidosis (DKA) is a life-threatening complication of Type 1 Diabetes Mellitus characterized by absolute insulin deficiency, leading to hyperglycemia, ketogenesis, and severe high anion gap metabolic acidosis.
Clinical Presentation:
- Polyuria, polydipsia, weight loss, vomiting, abdominal pain, Kussmaul respirations, and fruity breath odor.
Diagnosis:
- First-line: Capillary blood glucose and urine ketones.
- Gold Standard: Venous blood gas showing acidemia (pH < 7.30), low bicarbonate (< 15), and serum beta-hydroxybutyrate/ketones.
Management:
- Acute: Aggressive IV fluid resuscitation (normal saline), continuous IV regular insulin infusion, and careful potassium replacement (as insulin shifts K+ intracellularly).
- Long-term: Transition to a subcutaneous basal-bolus insulin regimen and comprehensive diabetes education.