A 5-year-old girl is brought is by her mother for two days of nausea, vomiting, diarrhea, and fever.  She has multiple sick contacts at home with the same.  She has no abdominal pain, change in behavior, or rash.  The girl is unable to tolerate a PO trial in the ED after antiemetics.  Her VS T 39.3 C HR 150 RR 22 BP 98/60.  She is well appearing but tired and moderately volume depleted on exam.  Her exam is otherwise normal.

IV fluids are given and a chemistry panel is drawn: Na 140 K 3.6 Cl 110 HCO3 22 BUN 18 Cr 0.8 Glucose 180.

She has no history of diabetes mellitus in the family, and has been well until this recent illness.  Her urinalysis shows no evidence of infection, a normal specific gravity, and no ketones.  After therapy, she feels much better and is now tolerating fluids and solids.

Regarding her hyperglycemia, which of the following is the BEST answer:

A. This is likely her first presentation of diabetic ketoacidosis (DKA)
       B.  This child likely has pre-diabetes
            C. Her hyperglycemia is due to her fever and viral syndrome
            D. This is a spurious result and will not require further testing

In the meantime, a quote --   "The physician can do all he has to do with speed and precision, but he must never appear to be in a hurry, and never absent-minded." -Theodor Billroth 1829-94


11/27/2012 6:26pm

C. Likely transient hyperglycemia secondary to stress response in setting of acute illness

11/28/2012 12:57pm

I would say c, likely stress hyperglycemia. Since this child has no evidence of a gap, no ketones in urine and normal bicarbonate I'd be comfortable sending them home with close follow up. I think kids with stress hyperglycemia are predisposed to type I in the future so close f/u is needed.


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