Child with an immediate life threatening medical emergency requiring resuscitation

Severe HAGMA and NAGMA, uncompensated. Possible additional respiratory acidosis.

Anion gap = 22

Delta ratio = 0.4

severe total body potassium depletion

Fluid deficit – high chloride, high Hb, high lactate

Normal renal function

High glucose

check ketones

Likely severe DKA

Life threats – airway (CNS depression), fluid deficit, potassium depletion, severe acidosis

Care with intubation – paralysis will worsen respiratory acidosis and pH – cardiac arrest immediate threat. Consider HCO3 pre intubation and hyperventilation at pre intubation RR.

Potassium deficit (mmol): Normal K (3.5) – actual K X body weight X 0.4

Daily requirement is 1mmol/kg

In patient NBM, potassium requirement is maintenance plus deficit

Potassium dose in children not to exceed 0.3-0.5 mmol/kg/hr