طفل عمره ٨ سنوات في الحماض الكيتوني السكري، بعد ٦ ساعات من العلاج والسكر يتحسن. فجأة صار يشتكي صداعاً شديداً، وصار نعساناً ومشوشاً، ونبضه نزل من ١٢٠ إلى ٦٤، والضغط ارتفع إلى ١٣٨/٨٨. ما الأرجح وما الإجراء؟

An 8-year-old in DKA, 6 hours into treatment with improving glucose, suddenly develops a severe headache, drowsiness and confusion; HR falls from 120 to 64 and BP rises to 138/88. What is most likely and what is done?

1. Hospital anxiety managed by reassuring the child and parents
2. Mild hypoglycaemia treated with oral juice and a repeat glucose
3. Normal resolution of DKA needing only sleep and rest on the ward
4. Cerebral oedema; notify immediately, reduce fluids and give mannitol as ordered

Answer: D) Cerebral oedema; notify immediately, reduce fluids and give mannitol as ordered. Cerebral oedema is a dangerous DKA complication in children, usually in the first 12 hours: headache, altered consciousness, bradycardia and hypertension. It needs immediate action.