Question

Patient 2: 12-year-old male with no past medical history, developmentally normal, and has recently been bullied at school - although he hasn’t told anyone. Immunizations are up to date. Likes to play lacrosse and is normally very active, but over the summer he has put on 15 pounds. His mother has noticed that he is drinking a lot of water and is up and down all night going to the bathroom. One younger sister with no issues. Currently raised by mother; father not regularly involved in care.

to complete your assignment:

• Offer three differential diagnoses for what might be troubling your patient.
• Provide rationale with citations for each of your differential diagnoses.
• What would be your first course of action for your patient?
• What safety issues, if any, did you recognize for your patient?
• Summarize the scenario and what you chose as your final diagnosis for your patient and why.
• Make sure that you address psychosocial issues/concerns/contributors, along with content related to substance abuse, should this be appropriate.
• This assignment should take no more than 1–2 pages, not including your title and reference pages.

Answer 1

According to the given history patient is affected by polydipsia and polyuria .

This may be due to :A- diabetes insipidus

B- diabetes mellitus

C- psychogenic diabetes insipidus .

Patient has no family history of diabetes mellitus and diabetes insipidus, he has little sister who has no symptoms like this, developmentally he is normal,has no past history of any medical illness . He is bullied at school that may cause mental disturbance in him.His mother tells that he drinks a lot of water and then goes to washroom frequently. All this indicates that he is suffering from any personality disorder or mentally disturbed. Among all there psychogenic diabetes insipidus is associated with psychiatric illness.thus ,probable diagnosis is psychogenic diabetes insipidus.

For this first action of course is the following tests: plasma osmolality

Urine osmolality

Urine sodium

Serum sodium

We should stop him from excessive fluid intake.Take him for behavioural and pharmacological therapy.There is no physical effect of it but it can cause hyponatremia.thus we should monitor serum sodium.If there is symptomatic hyponatremia treat it with hpertonic saline.

Final diagnosis is psychogenic diabetes insipidus because he is willingly drinking more water that cause frequent urination.he has mental disturbance because he is bullied in school by friends.

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