Article Text

PDF
An acutely collapsed patient
  1. Abhinav Singh1,
  2. Arnold Dunga2,
  3. Myooren Wimalendra2
  1. 1Royal Free Hospital, London, UK
  2. 2Department of Paediatrics, The Derriford Hospital, Plymouth, Devon, UK
  1. Correspondence to Dr Myooren Wimalendra, Department of Paediatrics, The Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK; mwimalendra{at}nhs.net

Statistics from Altmetric.com

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.

QUESTIONS

1. What is the most likely diagnosis?

  1. Diabetic ketoacidosis

  2. Non-ketotic hyperosmolar state

  3. Renal failure

  4. Pancreatitis

  5. Addisonian crisis

2. After aggressive fluid resuscitation, what is the next step in this patient's management?

  1. Inotropic support and antibiotics

  2. Parenteral hydrocortisone and …

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.