(a) A 23-year-old woman with type I diabetes mellitus presents with nausea, vomiting and altered sensorium. On examination, she…

(a) The presentation is diabetic ketoacidosis (DKA): hyperglycaemia >250 mg/dL, ketonaemia/ketonuria and metabolic acidosis, usually pH <7.3. The history should elicit insulin omission, infection, myocardial infarction, pancreatitis or drugs. Examination shows tachypnoea, altered sensorium and hypotension from volume depletion due to osmotic diuresis and vomiting. Initial assessment includes temperature, heart rate, blood pressure, respiratory rate, level of consciousness and urine output. Diagnosis is confirmed by random blood sugar, urine ketones, serum ketones, venous blood gas, serum electrolytes, renal function, complete blood count, ECG, blood and urine cultures, and chest X-ray if infection is suspected. Management is stepwise. First, ABC stabilisation: airway, oxygen if hypoxic, two large-bore IV lines, cardiac monitoring, urinary catheter, and correction of hypotension with isotonic saline. Give 0.9% saline 15–20 mL/kg in the first hour; thereafter replace deficits at 250–500 mL/hr (about 4–8 mL/kg/hr in a 60–70 kg adult), switching to 0.45% saline with dextrose when glucose falls to ~250 mg/dL. Start fixed-rate IV insulin 0.1 U/kg/hr, or a weight-based protocol, after confirming potassium is not <3.3 mEq/L; if K+ is 3.3–5.2, add potassium to fluids, if <3.3 hold insulin and replace potassium, and maintain serum potassium 4–5 mEq/L. Do not give bicarbonate unless pH <6.9. Monitor glucose hourly, electrolytes, ketones, fluid balance and mental status, watching for cerebral oedema. Continue insulin until ketones clear and acidosis resolves, then transition to subcutaneous insulin with overlap. Simultaneously identify and treat precipitating factors: infection, insulin omission, myocardial infarction, pancreatitis and drugs.

(b)(i) Acute diarrhoea in children is passage of three or more loose stools in 24 hours for less than 14 days. Causes are viral (rotavirus, norovirus), bacterial (ETEC, Shigella, Salmonella, Vibrio cholerae), protozoal (Giardia, Entamoeba) and non-infectious (antibiotic-associated, lactose intolerance); in India, rotavirus is a leading cause of severe acute diarrhoea in under-fives. Dehydration is assessed using IAP/IMNCI: no dehydration, some dehydration, severe dehydration and shock. Examine mental status (alert, irritable, lethargic), tears (present or absent), skin pinch (normal, slow, very slow), thirst and radial pulse (present, weak, not palpable); two or more abnormal signs indicate some dehydration, while severe signs or shock require urgent rehydration. Weighing, if available, helps estimate deficit, but clinical assessment guides immediate action. In severe dehydration, the child may be lethargic or unresponsive, with absent tears, very slow skin pinch, inability to drink and weak or absent radial pulse.

(b)(ii) Nutritional management is continued feeding without fasting: breast milk or formula, age-appropriate energy-dense foods, small frequent meals, low-osmolarity ORS for dehydration, and zinc 10 mg/day for children under six months or 20 mg/day for older children for 10–14 days; avoid sugary drinks. ORS should be given according to age/weight, and feeding should resume as soon as the child can drink. Prevention includes exclusive breastfeeding for six months, continued breastfeeding with safe complementary feeding, safe drinking water, sanitation, handwashing, ORS corner promotion and rotavirus vaccine under India’s UIP.

(c)(i) Eczema is a non-specific term for an inflammatory dermatosis with pruritus, erythema and epidermal changes such as scaling, vesiculation, crusting or lichenification. (ii) It is classified as endogenous—atopic, seborrhoeic, nummular, dyshidrotic, lichen simplex chronicus—and exogenous—contact, photodermatitis, stasis. (iii) Allergic contact dermatitis is type IV delayed hypersensitivity, requires prior sensitisation, has no dose threshold, is well-demarcated to the contact site though it may spread, and is caused by nickel or poison ivy. Irritant contact dermatitis is direct cytotoxicity, is threshold-dependent, occurs immediately or after repeated exposure, is confined to the contact site, and is caused by detergents or acids. ACD often recurs on re-exposure and may show vesicles; ICD recurs with continued irritant and shows burning, fissures or erosion. Thus, the approach is a structured, stepwise protocol.