A 4-year-old with diabetic ketoacidosis has been on IV fluids and an insulin infusion for 6 hours. Glucose has fallen from 520 to 240 mg/dL. She suddenly complains of headache, her heart rate drops from 140 to 96/min, she becomes irritable, and GCS falls from 15 to 11. What is the most appropriate immediate treatment?
- A Mannitol 0.5 to 1 g/kg IV over 10 to 15 minutes ✓
- B Stop insulin infusion and give a bolus of 20 mL/kg normal saline
- C Immediate non-contrast CT head before any treatment
- D IV furosemide 1 mg/kg
Correct answer: A. Mannitol 0.5 to 1 g/kg IV over 10 to 15 minutes
Explanation
Headache with a paradoxical fall in heart rate and declining consciousness during DKA treatment signals cerebral edema, the leading cause of DKA mortality in children. Treatment must be immediate and empirical: mannitol 0.5 to 1 g/kg or hypertonic saline 3 percent 5 mL/kg over 10 to 15 minutes. Waiting for CT delays life-saving therapy, which kills distractor C.
Reference: ISPAD Clinical Practice Consensus Guidelines / Nelson Textbook of Pediatrics, 2022 / 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.