An 11-year-old is admitted with new-onset diabetic ketoacidosis (DKA): blood glucose 612 mg/dL, pH 7.18, bicarbonate 8, ketones large. Which nursing actions reflect safe pediatric DKA management? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Pediatric DKA management priorities: GRADUAL isotonic fluid replacement (rapid boluses can precipitate cerebral edema), insulin drip 0.05-0.1 unit/kg/hr AFTER initial fluid and only when K+ ≥ 3.5, vigilant cerebral edema monitoring (the leading cause of pediatric DKA death), and potassium repletion as glucose drops with insulin. Choice 2 is wrong — bicarbonate is NOT routinely given in pediatric DKA except in extreme acidosis (pH < 6.9) due to association with worsened cerebral edema.
Pediatric DKA differs from adult DKA: cerebral edema is a leading killer (5-10% in children, rare in adults), so fluids are GRADUAL not aggressive, bicarbonate is generally avoided, and any new headache or LOC change during treatment is a STAT call. Insulin always AFTER fluids and after K+ check.
Pediatric DKA — Hyperglycemia + ketosis + acidosis in children; cerebral edema is the leading cause of mortality.
Cerebral edema warning signs — Severe headache, decreased LOC, Cushing triad (bradycardia, hypertension, irregular respirations), posturing, incontinence — STAT call.
Insulin in DKA timing — Start AFTER initial fluid bolus and only when K+ ≥ 3.5 mEq/L; insulin without K+ verification can precipitate fatal hypokalemia.