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A previously well 14-year-old boy presented with a 3-day history of diarrhoea and vomiting with a background of week-long coryzal symptoms. On arrival he was confused, tachycardic, tachypneic and hypotensive. His blood sugar in the ambulance was 3.0 mmol/L. In total, 15 mL/kg 0.9% saline bolus and 250 mL of 5% dextrose were given via intraosseous access in the emergency department. The patient was pyrexial with an elevated C reactive protein (63 mg/L), hence, prophylactic ceftriaxone (4 g intravenous) was commenced. His first venous blood gas showed:
pH 7.09, pCO2 5.28 kPa, PO2 4.61 kPa, BE −16.6, HCO3 11.4 mmol/L
Potassium 7.1 mmol/L, sodium 116 mmol/L, glucose 8.8 mmol/L, lactate 7.4 mmol/L, urea 11.9 mmol/L.
1. What is the most likely diagnosis?
Non-ketotic hyperosmolar state
2. After aggressive fluid resuscitation, what is the next step in this patient's management?
Inotropic support and antibiotics
Parenteral hydrocortisone and …
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