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let's go on to a case here we have an
otherwise healthy 9 year old girl who is
brought to the emergency room by a
father because of excessive thirst
frequent urination and significant
weight loss her symptoms started acutely
five days ago
vital signs reveal a temperature of 36
point six degrees Celsius a blood
pressure of a hundred over 65 and a
pulse rate of 105 beats per minutes
physical examination shows a thin girl
with dry mucous membranes and eyes that
appear sunken in her orbits labs reveal
a random a blood glucose of 410 a
c-peptide level that is undetectable and
a serum beta-hydroxybutyrate
level that is negative what is the most
likely diagnosis looking at this case
one first notices the age of the patient
a nine-year-old girl who comes in with
what seems like the classic symptoms of
diabetes
she has excessive thirst and frequent
urination but has also now associated
that with frequent with significant
weight loss and is more likely to
manifest with type 1 diabetes the
classic symptoms of hyperglycemia
polyuria and polydipsia are present here
in association with weight loss the
elevated glucose is caused by insulin
deficiency this leads to increased
glucose in the urine and a urine volume
which is called an osmotic diuresis she
has volume loss or excessive urination
from the body and this leads to
dehydration and worsens her symptoms
more acutely her heart rate is elevated
and her mucous membranes are dry and her
eyes appear sunken these are examination
features that bring you to the
conclusion that this patient has
dehydration probably a combination of
reduced oral intake combined with
increased urine output she suffers from
a lack of insulin and she is breaking
down protein stores to generate energy
which leads to the reduction in her body
mass index and causes her drop in weight
she has a clinical manifestation of
dehydrate
volume loss as evidenced by dry mucous
membranes tachycardia and reduced skin
turgor as well as a lower blood pressure
when one sees this manifestation of eyes
that appear sunken in the orbits it
generally implies clinically that the
dehydration is more advanced than one
would encounter without this
manifestation as you can see from her
labs her serum glucose is markedly
elevated at 410 milligrams per deciliter
as you know from the normal ranges this
exceeds a random plasma glucose of 200
greater than equal 200 milligrams per
deciliter and will clinch the diagnosis
of type 1 diabetes in this patient the C
peptide is undetectable and usually a
low C peptide indicates that there is a
lack of endogenous insulin secretion the
sort of thing that you would expect in a
patient who has type 1 diabetes which is
also it induced by autoimmune
destruction of the pancreas islet cells
the patient has a negative serum
beta-hydroxybutyrate level this is a
ketone body and suggests that she has a
key that the fact that is negative
suggests that she does not have a
ketoacidosis on top of her newly
diagnosed type 1 diabetes so our
conclusion here in this case is that the
most likely diagnosis for this girl is
that it is newly diagnosed type 1
diabetes
she has clinical signs of diabetes with
a random serum glucose greater than or
equal to 200 and classic symptoms
she's also presenting dehydrated the C
peptide which is undetectable implies
that there is decreased insulin
secretion endogenously and the fact that
her serum beta hydroxy butyrate level is
negative implies that she does not have
a ketoacidosis
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