Diabetic ketoacidosis


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Patient: Adam is a 16 year old male patient presented to A&E with vomiting and abdominal pain

Task:
This is a data interpretation station. You will be presented information by the examiner

This is a data interpretation station, you will be required to present information to the candidate. You are expected to give information in a neutral manor and are not allowed to probe or question answers given.

At the start of the station, please give the following information to the candidate. “You are a foundation doctor in A&E, a 16 year old male patient has attended with abdominal pain and vomiting.”

Category Question
Done
Excellent
Question Adam has a blood pressure of 110/70, respiratory rate of 35 and is apyrexial. Given the history which investigations would you like to order?
Erect chest x-ray (CXR alone does not score a mark)
Arterial blood gas (allow ABG)
Electrocardiogram (ECG)
Bloods
BM


Question
Review the following imaging and comment on your finding/s

No rotation, good inspiration, adequate penetration of film and good exposure (3 out of 4 for mark)
A - no tracheal deviation
B - lung fields clear
C - heart size normal (<50% of thorax diameter)
D - diaphragm /costophrenic angles clear


Question What is your overall impression of the chest x-ray?
Nil acute pathology


Question
Review the following bloods and comment on your finding/s

FBC - normal range
U&Es - urea raised with mild raised creatinine
U&Es suggest dehydration, hypokalaemia and possible AKI


Question
Review the following ECG and comment on your finding/s

Impression sinus tachycardia


Question At this stage what are your differentials?
Diabetic ketoacidosis (DKA)
Appendicitis
Gastroenteritis
Other appropriate answer


Question What further basic investigations would you like to order?
Arterial blood gas (ABG)
BM


Question
Review the following ABG and comment on your finding/s

Metabolic acidosis
With respiratory compensation


Question This patients BM is 35, what is your most likely diagnosis?
Diabetic ketoacidosis


Question Given this patient has diabetic ketoacidosis, what is your initial management plan for this patient?
IV access
Fluid replacement
Potassium replacement as required
Fixed rate insulin infusion



Score