Question

A 10-year-old child weighing 30 kg presents with a history of loose stools for 2 days. On examination, there is severe dehydration. Laboratory investigations are as follows. What is the initial management as per ISPAD guidelines?

RBS	550mg/dL
pH	7.01
Na+	158mEq/L
Urine glucose	3+

• A. Manage ABC, NS 20 mL/kg and start insulin after 1 hour
• B. Manage ABC, NS 20 mL/kg along with insulin 0.1 IU/kg/hr
• C. Manage ABC, NS 10 mL/kg along with insulin 0.1 IU/kg/hr
• D. Manage ABC, NS 10 mL/kg and start insulin after 1 hour

Answer 1

The Correct Option is A

In addressing the initial management of a 10-year-old child weighing 30 kg with severe dehydration and diabetic ketoacidosis (DKA), we follow ISPAD guidelines. The key parameters from the laboratory investigations are: RBS at 550 mg/dL, pH at 7.01 indicating acidosis, Na⁺ at 158 mEq/L indicative of hypernatremia, and urine glucose at 3+ which confirms significant glucose spillover in the urine.

According to ISPAD guidelines for managing DKA in children:

1. Manage ABC (Airway, Breathing, Circulation): Ensure that the airway is patent, breathing is adequate, and circulation is supported as a priority.
2. Rehydration: Administer normal saline (NS) at 20 mL/kg over 1-2 hours, given that the child presents with severe dehydration. For this child weighing 30 kg, the volume administered will be 600 mL (20 mL/kg x 30 kg).
3. Insulin Therapy: Start insulin therapy with a continuous infusion at 0.1 IU/kg/hr after the initial fluid bolus. However, it is crucial to delay the start of insulin until 1 hour after fluid resuscitation begins to avoid rapid changes in osmolality, which could lead to cerebral edema.

Therefore, the correct management option is to Manage ABC, NS 20 mL/kg and start insulin after 1 hour.