Sweet and Salty – fluids in DKA

During our training in paediatric emergency medicine most of us will have been cautioned repeatedly of the dangers of over-zealous fluid administration in children with diabetic ketoacidosis. Cerebral oedema is the feared complication of this disease process and, as traditional wisdom would have it, either rapid fluid administration or the use of any hypotonic IV…

You want how much?!

In discussion with your local PICU you have decided you are going to have to intubate the septic 11 month old in front of you. You know what you need; a fluid bolus, an adrenaline infusion, then a little bit of ketamine and some rocuronium, with push dose adrenaline on the side just in case….