CWH B0347225

 a

Here's a paediatric management plan for a 10-year-old boy with type 1 diabetes mellitus (T1DM) presenting with:

• Non-functioning insulin pump (recently changed by mum)

• Suspected infected infusion site (pus, lump, warmth)

• Unstable BMs (BM 17.6 mmol/L, ketones 0.1 at triage)

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🏥 Initial Assessment

• A–E assessment: Ensure ABCs are stable.

• Vital signs: Monitor temp, HR, RR, BP, cap refill, SpO₂.

• Neuro status: GCS, look for DKA signs (though ketones low).

• Blood glucose and ketone monitoring: Hourly initially.

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🧪 Investigations

• Bloods:

  • FBC, CRP (infection markers)

  • U&Es (renal function, dehydration)

  • Blood culture if febrile

  • HbA1c (optional for background)

• Wound swab of the infected site

• Capillary BMs and ketones: Hourly if unstable

• Consider urinalysis

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💉 Management Plan

1. Infection Control

• Remove the insulin pump immediately if not already done.

• Clean and dress the infected site.

• Empirical antibiotics (adjust per local guidelines & culture later):

  • Flucloxacillin IV if systemically unwell or oral if stable

  • Consider Clindamycin if MRSA suspected or severe

• Consider surgical opinion if abscess suspected

2. Glycaemic Control

• Switch to subcutaneous (SC) insulin injections temporarily:

  • Basal-bolus regimen:

    • Basal: e.g., Lantus or Levemir

    • Bolus: e.g., NovoRapid with meals

  • Alternatively, consider IV insulin if very unstable (e.g. continuous infusion with sliding scale + glucose)

• Check insulin requirements from pump to estimate SC doses

• Close paediatric diabetes team involvement

3. Fluids

• If clinical dehydration, start IV fluids (e.g., 0.9% NaCl +/- 5% glucose depending on glucose trends)

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👩‍⚕️ Monitoring

• Hourly BMs and ketones until stable

• 4-hourly vital signs

• Daily review of infection site

• Watch for signs of DKA (vomiting, abdo pain, tachypnoea)

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📞 Specialist Input

• Paediatric diabetes team: For insulin adjustment and pump management

• Paediatric surgery or plastics: If abscess or cellulitis progressing

• Infectious diseases/microbiology: If severe infection or antibiotic-resistant concerns

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📋 Discharge Planning

• Ensure site healed or healing well

• Patient and caregiver education on pump site care

• Re-commence insulin pump when safe

• Outpatient follow-up with diabetes team

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