Question

Your patient is a 10 year old girl brought to the ED by her mother who is a nurse. Mom reports that the girl has had nausea and vomiting for the last 24 hours. She has been unable to keep food or liquids down. She has also had excessive thirst, weakness, sob, and been drowsy.

You start an IV for fluids. The labs come back and her A1C is 15. What would you expect that her diagnosis will be? Discuss how you will educate the patient and her mom.

Answer 1

HbA1C of 15 indicates that the patient's blood sugars have not been in the normal range and have been very high in the past 3 months.

The symptoms that the patient has presented with are consistent with Diabetic Ketoacidosis: Nausea, Vomiting, Drowsiness and weakness.

The Child has diabetes. It can be either type 1 or type 2 although type 1 is more common in her age group.

The child will need further investigations including present blood sugars, serum and urine ketones, ABG etc. Any causes of sudden precipitation of DKA like infectons should also be checked.

The child will need insulin therapy that has to be continued through life.

Lifestyle and dietery changes can help with type 2 diabetes although in this case the chances of the illness being type 2 diabtetes is low.

The patient's mother should be educated regarding dietery changes that have to be made, importance of frequent checking of blood sugar, how to administer insulin and when to seek help. She should also be educated on the signs and symptoms of hypoglycemia to be watched for.