Pediatric DKA question

[Jay B]

Hello everyone, I'd like some clarification on a scenario question. The setting was pediatric DKA. 12 year old, decreased LOC, HR 120, BP 80 by palp, RR 44 with deep clear respirations.

What confuses me is that the correct treatment as per the instructor included ventilating with a BVM. There wasn't much time for questions after but she basically said ventilating was for the very fast respiratory rate. But to me it doesn't seem like this patient needs ventilations as his breaths are deep and clear. I thought the hyperventilation was in response to the acidosis as he's attempting to blow off CO2 to maintain blood pH, not because he has inadequate respiration, so the BVM would be pointless.

Thoughts?

 

[Carlos Danger]

You are correct.

A patient in DKA isn't breathing fast in order to compensate for ineffective gas exchange. In that scenario, assisting ventilations would be the right thing to do.

The hyperventilation seen in DKA, however, is a compensatory mechanism to attempt to raise serum pH by "blowing off Co2".

In severe cases, attempting to slow a compensatory tachypnea can be fatal. They are breathing fast for a reason.

 

[teedubbyaw]

Your instructor is wrong.

 

[Jay B]

Thanks guys!