Endocrinology: DKA cerebral oedema: practice question

A Pediatrics 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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Pediatrics · Endocrinology: DKA cerebral oedema

Sample item

On the fourth hour of DKA treatment a child develops headache, bradycardia, rising blood pressure and altered consciousness. What is the first treatment?

AIV mannitol 0.5 to 1 g/kg or hypertonic salineBGive bicarbonateCIncrease insulin rateDGive a bolus of 0.45 percent saline

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

The answer and the reasoning

A. IV mannitol 0.5 to 1 g/kg or hypertonic saline

Cerebral oedema is the commonest cause of death in paediatric DKA, with Cushing triad features. Mannitol or 3 percent saline is given immediately, fluids are reduced, and the head is raised. Imaging should not delay treatment.

Option by option

A. IV mannitol 0.5 to 1 g/kg or hypertonic saline (correct)
Correct. Osmotherapy is the immediate treatment.
B. Give bicarbonate
Bicarbonate is not helpful and may worsen CNS acidosis.
C. Increase insulin rate
More insulin lowers osmolality faster and worsens swelling.
D. Give a bolus of 0.45 percent saline
Hypotonic fluid worsens oedema.

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.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, IV mannitol 0.5 to 1 g/kg or hypertonic saline. Cerebral oedema is the commonest cause of death in paediatric DKA, with Cushing triad features.

Why is "Give bicarbonate" not the answer?

Bicarbonate is not helpful and may worsen CNS acidosis.

Why is "Increase insulin rate" not the answer?

More insulin lowers osmolality faster and worsens swelling.

Why is "Give a bolus of 0.45 percent saline" not the answer?

Hypotonic fluid worsens oedema.

What concept does this question test?

It tests Endocrinology: DKA cerebral oedema in Pediatrics. Mannitol or 3 percent saline is given immediately, fluids are reduced, and the head is raised. Imaging should not delay treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: DKA cerebral oedema?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.