Paediatricsmiddle twist
A 9-year-old girl weighing 30 kg presents in diabetic ketoacidosis as the first presentation of type 1 diabetes: pH 7.02, glucose 34 mmol/L, bicarbonate 6 mmol/L, moderately dehydrated. She receives a 10 mL/kg bolus of 0.9% sodium chloride, then maintenance-plus-deficit fluids and an insulin infusion at 0.1 unit/kg/hour. Four hours later she complains of a severe headache and becomes increasingly drowsy; her heart rate falls from 130/min to 58/min and her blood pressure rises to 142/92 mmHg. Her glucose is 19 mmol/L and pH 7.18.
Which one of the following is the most appropriate immediate management?