What this deck covers
Diabetic Ketoacidosis in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.
Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.
The 18 cases, in order
- What has to be true to call it this
- How bad is this one
- Does he need one now
- When to switch the pump on
- How fast to run it
- A normal reading that misleads
- A low result at the outset
- Better readings, worse child
- Act before you image
- Sugar down, ketones still up
- Should the acid be corrected
- Recovery that looks stalled
- Not very high, still in trouble
- How closely to watch
- Coming off the drip
- The same child, again and again
- Drowsy and being sick
- Small, young and very sick
Diagnoses and management options tested
Across the 18 cases you are asked to choose between options such as: Ketones present but the blood is not acidotic, Moderate, A bolus of 10 mL/kg of human albumin, Give a loading dose now, then an infusion, 1 unit per kilogram per hour, The measured level is actually low for a child, Start insulin and add potassium at the same time, Cerebral oedema, Stop the insulin infusion, Change to subcutaneous insulin and stop the infusion, Give it once the pH falls below 7.0, A hyperchloraemic acidosis from the saline, A laboratory error in the ketone measurement, Continuous cardiac monitoring on its own.
Clinical pearls from this deck
- Three legs, and all three must be there: sugar up, acid down, ketones present.
- Grade on the acid. A child who looks well can still be in the severe group.
- No shock, no bolus. Fluid given too fast is the one thing you can do that makes it worse.
- Fluids first, insulin an hour or two later, and never a loading dose.
- The insulin is there to stop ketone production; the falling glucose is just a by-product.
- A normal potassium in ketoacidosis is a trap: the stores are empty whatever the number says.
Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.
More from this system: all Endocrinology Board Questions case decks · pediatric reference values.
