TY - JOUR T1 - An acutely collapsed patient JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed SP - 238 LP - 238 DO - 10.1136/archdischild-2015-308506 VL - 101 IS - 5 AU - Abhinav Singh AU - Arnold Dunga AU - Myooren Wimalendra Y1 - 2016/10/01 UR - http://ep.bmj.com/content/101/5/238.abstract N2 - 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/LPotassium 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? Diabetic ketoacidosisNon-ketotic hyperosmolar stateRenal failurePancreatitisAddisonian crisis2. After aggressive fluid resuscitation, what is the next step in this patient's management? Inotropic support and antibioticsParenteral hydrocortisone and … ER -