#PEST2015: Diabetic Ketoacidosis
““15-year-old, self-presentation. 1-week history of vomiting and lethargy, feeling worse overnight, receptionist concerned patient looks unwell.””
Observations
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.
Learning outcomes
It is appropriate to speak up if you have concerns regarding a clinical situation whatever your grade/job title.
Try to verbalise your thinking as this helps keep the team focussed and ensures everyone is working towards the same priorities.
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.
