Diabetes mellitus (pediatrics) Quiz: Ace Your Exams
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A 3-year-old girl is brought to the emergency department for vomiting and progressive abdominal pain for two days. Her parents report she has been drinking more water lately and wetting the bed at night after previously having dry nights. Past medical and family history are unremarkable. Temperature is 36.8°C (98.2°F), pulse is 125/min, respirations are 38/min, blood pressure is 108/65 mm Hg and oxygen saturation is 94% on room air. Mucous membranes are dry with poor skin turgor. The patient is tachypneic with deep, labored breathing and a fruity smell to the breath. Lungs are clear bilaterally. Cardiac and abdominal exams are unremarkable. Labs are shown below. Which of the following is the best next step in management?
| Laboratory value | Result |
| Blood glucose | 530 mg/dL |
| Serum sodium | 146 mEq/L |
| Serum potassium | 3 mEq/L |
| Serum beta-hydroxybutyrate (BHB) | 7 |
| PH | 7.02 |
| PCo2 | 50 mmHg |
| Serum bicarbonate | 10 mEq/L |
| Urine ketones | Positive |
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