Ominous

A 4 year old girl presents with mild abdominal pain and vomiting since last night. There is no history of fever, diarrhea, or urinary symptoms.

Her parents mention that she lost some weight during the previous month, despite a good appetite.

Her medical, family and birth histories are unremarkable.

Select Relevant Investigations
Full Blood Count

Performed

WBC: 11,000/mm3
N 70%, L 25%
Hb: 13 g/dL
Hct: 40%
Platelets: 350,000/mm3
Capillary Blood Glucose

Performed

Her capillary glucose level is 720 mg/dl
A blood ketone level is performed and is found to be 4 mmol/l (normal: < 0.6 mmol/l)
Renal profile

Performed

Urea: 13 mg/dl (7 - 20 mg/dl)
Creatinine: 0.6 mg/dl (0.2 - 1 mg/dl)
Na+ 140 mmol/l (135 - 145 mmol/l)
K+ 3.9 mmol/l (3.5 - 5 mmol/l)
Cl- 99 mmol/l (98 - 108 mmol/l)
Venous blood gases

Performed

pH: 7.25
PCO2 : 45 mmHg
PO2 : 60 mmHg
HCO3: 10.3 mmol/l
Base excess: -15.0 mmol/l

Select Relevant Management
Nil orally
IV 0.9% saline bolus
IV insulin bolus
IV Sodium Bicarbonate