A 16 year old patient presents critically unwell with severe life threatening diabetic ketoacidosis, in severe shockSevere triple acid base disorder:

HAGMA

NAGMA

uncompensated/ additional respiratory acidosis

Critical shortage of K

Mild hypernatraemia/ hyperchloraemia

High glucose

High lactose

Issues:

Shock requiring resuscitation – care with fluid replacement

Severe hypokalaemia requiring K++

Young patient – will require transfer to tertiary hospital

Young patient – distraught family

Intensive management required – drain on resources

Undiagnosed diabetes – ongoing care/ education required

Treatment:

Resuscitate – ABC approach

Fluid

Replace K – likely require central access

Insulin

Consider HCO3 pre intubation if required

Treat cause

Arrange transfer and escort