Indian Paediatrics & Critical Care
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Interactive 1-by-1 timed OSCE stations mode with question palette & examiner solutions.
A 4-year-old child presents with lethargy, cold peripheries (CRT 4s), and tachycardia (HR 165/min). ABG shows: pH 7.12, PaCO2 22 mmHg, PaO2 92 mmHg, HCO3 7 mEq/L, Lactate 6.8 mmol/L, Na 138 mEq/L, Cl 102 mEq/L.
Questions:
1. Interpret the ABG completely including Anion Gap.
2. State 3 immediate emergency management steps.
1. ABG Interpretation:
• Primary Diagnosis: Severe High Anion Gap Metabolic Acidosis with partial respiratory compensation.
• Anion Gap = Na - (Cl + HCO3) = 138 - (102 + 7) = 29 mEq/L (Normal 12 +/- 2 mEq/L).
• Hyperlactatemia (6.8 mmol/L) indicates severe tissue hypoperfusion.
2. Emergency Management Steps:
a) Administer 10-20 mL/kg Isotonic Crystalloid bolus (0.9% Normal Saline or Ringer's Lactate) over 10-15 mins.
b) Initiate Adrenaline inotrope infusion (0.05 - 0.2 mcg/kg/min) for cold septic shock.
c) Establish airway & high-flow oxygenation, obtain blood cultures, and administer IV broad-spectrum antibiotics within 1 hour.