Paediatric Appendicitis with New Diagnosis of DKA

You are the duty anaesthetist in a regional hospital. You are called to the Emergency Department by the surgical registrar to review an 8-year-old boy who has been booked for an urgent appendicectomy. The child has been previously well and presents with a three day history of abdominal pain and vomiting. An ultrasound has been performed which suggests appendicitis. The surgical registrar would like to operate as soon as possible as he thinks the child is showing signs of sepsis. Initial information on booking: weight 25 kg, pulse 150 bpm, BP 80/40 mmHg, RR 45 bpm, temp 37.3 degrees C FBC: Hb 120 g/L (110-155), WCC 17 x10^9/L (4-11.0), Plt 250 x10^9/L (140-400) Electrolytes: Na 133 mmol/L (133-144), K 3.5 mmol/L (3.6-5.3), Cl 104 mmol/L (97-110), Bicarbonate 8 mmol/L (22-29), Urea 5.0 mmol/L (2.7-7.8), Creatinine 35 micromol/L (20-44)