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
Range

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.