When you suspect diabetes in a child Editor's key points
Canadian Family Physician | Le Médecin de famille canadien }
A 2-year-old boy presented to the local emergency department (ED) with diabetic ketoacidosis (DKA). Findings of a physical examination showed tachycardia, dry mucus membranes, and pallor. He had appreciable wasting of his proximal muscles. His mother reported that he had lost almost 3 kg in the preceding 3 months. Earlier on the day of presentation, he had drunk 70 oz of fluid, and he had had in excess of 12 wet diapers in the previous 24 hours. One week before presentation, his mother had
... him to a physician reporting increased thirst and voiding, and that she was worried about diabetes. Her concerns were not validated, but she was provided with a laboratory requisition form to check glucose levels. The bloodwork was not done until he presented with DKA in the ED 1 week later. The patient was treated according to the local pediatric DKA protocol and recovered well. Case 2 A 12-year-old boy presented to the local ED with DKA. He had a 1-month history of polyuria and polydipsia and had lost almost 14 kg. He also reported nausea for 3 days before presentation. Before the day of diagnosis, he had visited a walk-in clinic where he received a laboratory requisition form to measure serum blood glucose levels. That afternoon, laboratory results revealed a serum blood glucose level of 39.5 mmol/L; however, these results were not seen by the physician, as the office had closed for the day. The following day, his parents sought advice from their own family physician who checked the laboratory results and sent them to the ED. At initial presentation, the boy had moderate DKA and there were concerns about his level of consciousness. He was treated as per the pediatric DKA protocol and recovered well. Case 3 A 19-month-old girl was diagnosed with type 1 diabetes after referral by her primary care physician. Her parents reported a 2-week history of progressive increase in voiding and thirst. She was soaking through all her diapers and had stopped napping owing to the thirst. Four days before diagnosis, a physician had seen her for a follow-up after she had taken antibiotics for acute otitis media. At that visit, her mother reported symptoms of increased thirst and voiding. At a follow-up with the same physician 2 days later, she reported specific complaints of increased voiding and thirst. Although a laboratory requisition form was provided, the blood-collection clinic was closed that day. The following day bloodwork results revealed hyperglyce-mia and not DKA. The patient was referred to the pediatric diabetes clinic but was ultimately hospitalized because the required education could not be completed owing to late-day presentation to the diabetes clinic. Discussion The MEDLINE database was searched for English-language articles related to the diagnosis of diabetes in children and the potential risks of DKA. The Canadian Diabetes Association and International Society for Pediatric and Adolescent Diabetes guidelines were used to outline the approach to diagnosis of diabetes in children. 1,2 Cases that are known to us are used to illustrate the potential risks of delaying a diagnosis of diabetes.