A 4-year-old with diabetic ketoacidosis develops headache, bradycardia with rising blood pressure, and a decreasing level of consciousness two hours after starting fluid therapy. What is the immediate next step?

• A Give mannitol 0.5 to 1 g/kg IV over 10 to 15 minutes at the bedside ✓
• B Obtain urgent CT scan of the head before starting any drug
• C Stop all fluids and give furosemide 1 mg/kg IV
• D Administer 3% saline only after confirming serum sodium has fallen below 130 mEq/L

Explanation

These are classic signs of cerebral edema, the leading cause of death in pediatric DKA, and treatment must begin at the bedside without waiting for imaging because delay costs lives. Mannitol 0.5 to 1 g/kg over 10 to 15 minutes is the standard first-line agent, with 3% hypertonic saline as an alternative. Furosemide is ineffective for cytotoxic cerebral edema, and withholding fluids worsens shock in these patients.

Reference: Nelson Textbook of Pediatrics, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.