Tuesday, July 30, 2013

Sweeter than Sugar





I haven't got one good night sleep this week.  I think it's because I've had a lot worried parents. I've been making my rounds more than twice a day.  Just to check if they are getting better. (or worse!)

And just when I think I've been paddling like crazy to stay afloat, another unusual case comes my way to give me  additional thoughts in my head.


I can't deny that I have thought of giving silly excuses to send them away to a bigger hospital where they can share their bed with two other patients with a different illness.

What the heck, what's with one different case...
( Did I mention that I also have one newborn with pneumothorax and two babies with hemorrhagic disease of the newborn? All at the same time. Unbelievable.)

This child is four years old. She came in because the she has vomiting , severe weight loss and  refuses to feed.This is our first encounter.

She's the only child of this young couple.

She was dehydrated , had vomiting and abdominal distention.She neither had diarrhea, fever, masses, pains nor rashes. She had no exposure to tuberculosis too.  She  started to loose weight just this second week of June. Mom added that even during the times she was losing weight, she eats and drink a lot too.

And her mom asked me in passing if it's okay to let her drink milk because she loves drinking a lot of it... (hmm...i asked again her mom if this kid really  love milk because with a weight of 11 kilos at four years old, her love for milk doesn't really show much)

I had her checked by the surgeon. Just in case there is something that needs to be surgically removed that is causing this abdominal distention and muscular wasting.

Cleared.

There was nothing surgical about this child the surgeon said...from here on ends you have to deal with her on your own.( I don't know if the surgeon said that or if that was how I really felt..)

That's when my headache began. I knew ,there is a list of differential diagnosis for this type of thing. I  guess the answer is still hidden somewhere in my mind.(Oh no... I need to unlock it...fast!)

As I was trying to draw inspiration ,I sat by her bedside.I did and redid my history, physical exam and review of systems. Still , I knew I was missing something.  Its that one word at the tip of my tongue , which ,BTW ,I want to spit out and read out loud.

Suddenly, I got it!! She smelled nice and fruity.



It's diabetes. Everything fell into its place.

Her random blood sugar was 544 mg/dl , it's almost 4x the normal!

My headache just became stroke in evolution. My cerebral artery wanted to explode.

Hell, is it me?! Do I like making parents cry? Or weird cases just loves following me around.




What is Diabetes Mellitus in children?

Diabetes mellitus is a common, chronic metabolic disorder heralded by hyperglycemia or increased blood sugar.

 Major forms of diabetes are classified according to deficiency of insulin:
a. Type 1 DM- due to pancreatic beta cell damage
b. Type 2 DM- due to insulin resistance

Type 1 diabetes mellitus is the most common metabolic disorder of childhood and adolescence.

Type 1 diabetes mellitus is an autoimmune kind of disease (meaning...the body develops a defense against himself. ) But whatever triggers this autoimmune response is still unclear.

Genetics, environmental factors, virus and diet are contributory factors to the initiation and progression of this disorder.

Is there a test to determine if a newborn has this problem? Sad, but there is no universally accepted effective intervention yet.

Most of the time, manifestations are non specific and can range from difficulty of breathing, vomiting ,sleeping most of the time or, simply,  flu like symptoms. While other sypmtoms like drinks a lot or gets thirsty a lot (polydipsia), pees a lot(polyuria) and eats a lot (polyphagia) can also be seen in children. Those are not the reasons for seeking consult or admissions.

Treatment is insulin.
 

What happened to our child??

She was given insulin and was sent home after a few days.

It's like carefully fixing the messy cable wires  with a tie wire without shutting the computer down.

This is the one instance I couldn't tell this baby girl to...STAY AS SWEET AS YOU ARE...because it's going to kill you!



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