QuestionSBA
QuestionChoice
This patient has diabetic ketoacidosis. This can be inferred due to the high blood glucose, high blood ketones and acidosis seen on the ABG. The first thing that should be prescribed and given in DKA is a 500ml fluid bolus STAT, then a fixed rate insulin infusion should be set up.
50310
b
Prescribe and give a fixed rate insulin infusion of 0.1 units/kg/hour first
QuestionChoice
This patient has diabetic ketoacidosis. This can be inferred due to the high blood glucose, high blood ketones and acidosis seen on the ABG. The first thing that should be prescribed and given in DKA is a 500ml fluid bolus STAT, then a fixed rate insulin infusion should be set up.
50309
a
Prescribe and give 500ml of 0.9% NaCl STAT first
QuestionChoice
Whilst you would want to give a fluid bolus first, 250ml is not enough. There is no evidence in the stem of the question that you should be concerned about fluid overload in this patient therefore 500ml STAT is an appropriate volume of fluid to give.
50313
e
Prescribe and give 250ml of 0.9% NaCl STAT first
QuestionChoice
This patient has diabetic ketoacidosis. This can be inferred due to the high blood glucose, high blood ketones and acidosis seen on the ABG. The first thing that should be prescribed and given in DKA is a 500ml fluid bolus STAT, then a fixed rate insulin infusion should be set up.
50312
d
Prescribe and give a fixed rate insulin infusion of 1 units/kg/hour first
QuestionChoice
This is an incorrect option. This patient is in DKA and needs pharmacological intervention otherwise their condition will deteriorate.
50311
c
Continue to monitor observations, blood glucose and blood ketones
QuestionComment
BP syslotic is above 90 so you don't give NaCl STAT, it's given over an hour 1L
17538
QuestionComment
He's normotensive but still critically dehydrated. He is just compensating well. His intracellular and extravascular fluids are still low so you would still give stat fluids
61444
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Syed
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Malignant Endoscope
QuestionComment
even 500ml bolus in children?
38186
QuestionComment
Paediatric fluid bolus is 10mL/kg but we are not given his weight here...
38650
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Yersinia Jaundice
QuestionComment
I think 16 is the cut off for adults, is it not?
39765
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Just Another Med Student
QuestionComment
i thought so too but i guess on average a 16yr old is prob around 40kg and so around 400 makes sense i guess... or in dka its always 500ml
61646
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Kussmaul Sign
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Sunny
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3645
The first line management of diabetic ketoacidosis
Topic
91
Paediatrics
10116
Case Presentation: A 16 year old boy is brought to the emergency department with shortness of breath. His mother says he has been complaining of feeling really thirsty for the last couple days. 




 **PH** Nil.


 **DH** Nil. NKDA


 **On examination**
Temperature 37.6°C, HR 104, RR 24, BP 114/72, O2 95% RA.


Respiratory exam: deep laboured breathing seen.


 **Investigations**

||||
|--------------|:-------:|------------------|
|pH|7.31|7.35 - 7.45|
|PaO₂|8.0 kPa|11 - 15|
|PaCO₂|3.8 kPa|4.6 - 6.4|
|Bicarbonate|23 mmol/L|22 - 30|


Blood glucose: 22 mmol/L (<6.1 mmol/L)


Blood ketones: 3.4 mmol/L (normal <0.6 mmol/L)


Question: Select the most appropriate management at this stage.
a