SAQ Stack

Short Answer Questions for ED Fellowship Study

Case: Paediatric diabetic ketoacidosis with cerebral oedema

A 10-year-old girl has presented to your urban district emergency department at 3pm with fever and feeling lethargic for the past week, vomiting 3 x today. The child is unable to tolerate oral intake. On examination : Weight 40kg

  • HR 150
  • BP 100/80
  • RR 40
  • Sats 100%RA
  • Temp 38.5˚C
  • GCS 15
Central CR 4 seconds BSL 23 S. ketones 6

1. State (3) assessment variables, including cut-offs, that help stratify and indicate sever to life-threatening DKA 3 marks

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pH 7.2 pCO2 28 HCO3 8 Lactate 2 Na 128 K 4.5 Cl 100 iCa 1.22 Glucose 23 Urea 10 Creat 70

2. Demonstrate the calculation for the patient’s corrected serum Na. 1 mark

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3. Demonstrate the calculation for the patient’s anion gap. 1 mark

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4. Demonstrate the calculation for the patient’s serum osmolality. 1 mark

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After many hours in the ED, the patient is still awaiting transfer to a tertiary Paediatric Hospital. Towards the end of your evening shift, you are called to attend as the patient’s GCS has dropped from 14 to 9.

5. State the likely cause and your management priorities 6 marks

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This case forms part of a collaborative marking project designed to support fellowship preparation. In the week leading up to each tutorial, you can contribute answers to any active case. If you contribute, your answers may be reviewed, marked, and used to refine the model answers during the weekly fellowship teaching sessions.

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After the tutorial you can still do the case and self-mark your answers, but your answers will not be included in the group review.