ABP Pediatric Endocrinology Practice Questions - ABP Pediatric Endocrinology Subspecialty Certification Examination Exam

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A 7-year-old in DKA presents with glucose 520 mg/dL, pH 7.05, HCO3 6, Na 132, K 5.4, and BUN 28. Per ISPAD/PES guidelines, which initial fluid strategy is most appropriate?

10 mL/kg isotonic saline bolus over 30-60 minutes if needed, then replace deficit over 24-48 hours with maintenance; avoid cumulative fluids >40 mL/kg in the first 4 hours Aggressive 40 mL/kg bolus over 1 hour followed by D5 half-normal saline at 2x maintenance Fluid restriction to two-thirds maintenance to prevent cerebral edema Bolus with D10 half-normal saline to treat hyperglycemia

Correct Answer:

10 mL/kg isotonic saline bolus over 30-60 minutes if needed, then replace deficit over 24-48 hours with maintenance; avoid cumulative fluids >40 mL/kg in the first 4 hours

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