Paediatrics
Scenario:
“Your Paediatric Intensive Care colleagues have asked you for advice regarding a 10 year old boy
with insulin dependent diabetes mellitus since the age of 2 years. His diabetes is poorly controlled due to poor patient compliance. Prior to this admission, he had flu like symptoms for two weeks with a sore throat and cough. Twenty four hours prior to admission, he experienced nausea and vomiting with severe epigastric pain.
His initial biochemistry reveals:
|
Units |
Reference |
||
|
Sodium |
136 |
mmol/L |
135-145 |
|
Potassium |
4.8 |
mmol/L |
3.2-4.5 |
|
Chloride |
102 |
mmol/L |
100-110 |
|
Bicarbonate |
10 |
mmol/L |
22-33 |
|
Anion Gap |
24 |
mmol/L |
5-15 |
|
Creatinine |
0.072 |
mmol/L |
0.070-0.120 |
|
Urea |
4 |
mmol/L |
3.0-8.0 |
|
Albumin |
24 |
g/L |
33-47 |
|
Ionised Calcium |
1.33 |
mmol/L |
1.13-1.30 |
|
pH |
7.27 |
mmol/L |
7.35-7.45 |
|
Glucose |
27 |
mmol/L |
3.0-5.5 |
|
AST |
52 |
U/L |
10-45 |
|
ALT |
90 |
U/L |
5-45 |
|
ALP |
171 |
U/L |
70-250 |
|
Total Bilirubin |
14 |
micromol/L |
<20 |
|
Lipase |
4536 |
U/L |
25-300 |
|
Amylase |
277 |
U/L |
40-130 |
|
Lactate |
3.6 |
mmol/L |
0.2-2.0 |
Please identify and discuss the major abnormalities”
Follow up question: “What are the possible causes of this presentation”
Twenty-five out of twenty-seven candidates passes this station.
Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.