A 12-year-old newly diagnosed diabetic presents in DKA with pH 7.08, glucose 520 mg/dL, and clinical dehydration estimated at 7%. The most feared complication of DKA management in children and the single most important preventive measure is:

• A Hypoglycemia — prevented by adding 5% dextrose when glucose falls below 250 mg/dL
• B Hypokalemia — prevented by early potassium replacement regardless of serum level
• C Aspiration pneumonia — prevented by NGT insertion in all DKA patients
• D Cerebral edema — prevented by avoiding overly rapid fluid administration and isotonic fluid rehydration ✓

Explanation

Cerebral edema is the most dreaded complication of DKA in children, responsible for 57–87% of DKA-related deaths. The key preventive strategy is judicious, not overly rapid, fluid replacement using isotonic fluid (normal saline). Rapid fluid shifts and hypotonic solutions increase risk. While glucose monitoring, potassium replacement, and airway protection are all important, none is specifically directed at the most feared complication.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.