Question

The parents of a 4 year old female check her into the emergency room after they found her in her room in a stupor. She could not answer the basic questions they asked. The parents are worried she may have overdosed. They noticed there were lots of water bottles and candy wrappers in her room. Although she eats and sleeps all of the time, she never gains weight and is always tired. She urinates a lot.

determine which part of the endocrine system could be experiencing problems. List some other info that could confirm or rule out your initial diagnosis (test you might be able to run on patient). Explain your reasoning.

Answer 1

Answer:

The facts: 4 year old / excessive thirst (water bottles) / hunger and craving for sweets (candy wrappers) / does not gain weight although she eats and sleeps well / feels tired most of the time / urinates a lot

All of the above point to Diabetes Mellitus Type I Juvenile onset.

The insulin in the body is not being produced at all or produced very little. The child in stupor has overdosed on sugar and hence the coma like status. Immediate check should be for blood glucose by finger prick to ascertain the blood glucose levels before putting her on insulin and other medications. More tests in the meanwhile should be sent to laboratory to check for level of insulin / electrolytes / kidney functions and liver functions. Test for pancreatic amylase and lipase would also help if physical examination suggests to the same. Urine should be checked for sugar and ketone bodies if collected.

Type I DM or Insulin dependent DM (IDDM) has most commonly juvenile onset though the age of 4 years is early for this to manifest. Parent's medical and family history would help in this case to understand the early onset. in IDDM the cells in pancreas do not produce insulin and hence body can not utilize glucose properly. This leads to hyperglycemia. Once the blood levels of glucose exceed the kidney threshold, kidney will not be able to absorb back all of the glucose and hence it will be excreted in urine. This will impair the functioning of kidneys. As electrolytes too are re-absorbed in kidney, there will be effect on their re-absorption as kidney function is impaired. As liver will start storing the excess glucose in the body, liver functions too will get disturbed.

As body is no longer able to use glucose, it will use the fat reserves leading to formation of ketone bodies, and to ketoacidosis.

All the above test results will help confirm the differential diagnosis and help in further management of the case.