#PEST2015: Diabetic Ketoacidosis

#PEST2015: Diabetic Ketoacidosis

“15-year-old, self-presentation. 1-week history of vomiting and lethargy, feeling worse overnight, receptionist concerned patient looks unwell.”


RR – 30-40

SpO2 – 91% in air

HR – 130

BP – 100/40

CRT – 4 secs

Clinical findings

  • Drowsy but rousable, can talk appropriately.

  • BM reads HI.

  • Blood ketones 6.

  • Significant metabolic acidosis on venous blood gas.


Why we simulated?

Cerebral oedema is a serious complication of DKA and requires awareness of the presenting features and judicious fluid administration to minimise the chances of an iatrogenic component to the condition.

Image: Rachel Rowlands ( @rachrwlnds )

Image: Rachel Rowlands (@rachrwlnds)


Learning outcomes

  1. It is appropriate to speak up if you have concerns regarding a clinical situation whatever your grade/job title.

  2. Try to verbalise your thinking as this helps keep the team focussed and ensures everyone is working towards the same priorities.

  3. Importance of cautious fluid administration to prevent cerebral oedema.

Positive feedback

  • Considered wide range of diagnoses for teenager with reduced conscious level.

  • Followed local protocol for the treatment of DKA.

  • Recognised that “specialist” suggesting inappropriate fluid resuscitation and ensured only appropriate fluids administered.

Edit & Peer Review by Jamie Sillett


#PEST2015: Major Trauma

#PEST2015: Major Trauma