Diabetes mellitus (pediatrics) Quiz: Ace Your Exams
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A 7-year-old boy is brought to the emergency department for vomiting, diarrhea and decreased oral intake for 3 days. His younger brother who is in daycare has similar symptoms. The patient was diagnosed with type I diabetes mellitus (DM) at 4 years of age and is on insulin therapy. The parents did not give him insulin today because he has not been eating. The patient sees an endocrinologist every 3 months and attends regular well-checks with his pediatrician. Temperature is 37.0°C (98.6°F), pulse is 90/min, respirations are 20/min, and blood pressure is 100/66 mm Hg. On physical examination, the child appears tired. He is dressed appropriately for the season and caregivers are attentive to him. Dry mucous membranes are noted, and capillary refill is > 3 seconds. Cardiopulmonary and abdominal examinations are unremarkable. The patient is admitted to the hospital and stabilized. Initial labs are shown below. Which of the following is the best next step in management?
| Laboratory value | Result |
| Blood glucose | 230 mg/dL |
| Serum sodium | 144 mEq/L |
| Serum potassium | 3.5 mEq/L |
| PH | 7.35 |
| PCo2 | 32 mmHg |
| Serum bicarbonate | 20 mEq/L |
| Urine ketones | negative |
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