A 7-year-old girl with type 1 diabetes admitted for DKA improves initially on intravenous fluids and insulin. Eight hours into therapy she develops severe headache, bradycardia, hypertension, and a falling Glasgow Coma Scale score. What is the most appropriate immediate intervention?

• A Increase the rate of isotonic fluid infusion
• B Immediate lumbar puncture
• C Rapid correction of the remaining sodium deficit
• D Intravenous mannitol or hypertonic saline ✓

Explanation

Cerebral oedema is the leading cause of mortality in paediatric DKA, classically appearing 4 to 12 hours after starting treatment. Headache with bradycardia and hypertension reflects raised intracranial pressure (Cushing response). Mannitol 0.5 to 1 g/kg intravenously over 15 minutes, or hypertonic saline if unavailable, is the emergency treatment. Giving more fluid worsens the oedema, and lumbar puncture delays definitive therapy and risks herniation.

Reference: ISPAD Clinical Practice Consensus Guidelines, 2022 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.