Endocrinology and diabetes: cerebral oedema in paediatric DKA: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology and diabetes: cerebral oedema in paediatric DKA

Sample item

A 9-year-old with newly diagnosed type 1 diabetes in ketoacidosis improves on treatment, but 6 hours later develops headache, vomiting, bradycardia and drowsiness. Which complication is most likely?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Cerebral oedema

Cerebral oedema is the most serious complication of paediatric DKA, usually appearing 4 to 12 hours after treatment starts. Headache, vomiting, falling heart rate and altered consciousness are warning signs, and treatment is hyperosmolar therapy with mannitol or hypertonic saline.

Option by option

  • A. Central pontine myelinolysis

    Myelinolysis follows rapid sodium correction and presents days later with quadriparesis.

  • B. Subarachnoid haemorrhage

    Subarachnoid haemorrhage is uncommon in children and gives sudden severe headache.

  • C. Cerebral oedema (correct)

    Correct. The timing and rising intracranial pressure features indicate cerebral oedema.

  • D. Hypoglycaemia

    Hypoglycaemia gives sweating and tachycardia rather than bradycardia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Cerebral oedema. Cerebral oedema is the most serious complication of paediatric DKA, usually appearing 4 to 12 hours after treatment starts.

Why is "Central pontine myelinolysis" not the answer?

Myelinolysis follows rapid sodium correction and presents days later with quadriparesis.

Why is "Subarachnoid haemorrhage" not the answer?

Subarachnoid haemorrhage is uncommon in children and gives sudden severe headache.

Why is "Hypoglycaemia" not the answer?

Hypoglycaemia gives sweating and tachycardia rather than bradycardia.

What concept does this question test?

It tests Endocrinology and diabetes: cerebral oedema in paediatric DKA in General Medicine. Headache, vomiting, falling heart rate and altered consciousness are warning signs, and treatment is hyperosmolar therapy with mannitol or hypertonic saline.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology and diabetes: cerebral oedema in paediatric DKA?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.