A case of dignostic curiocity--yet another pediatric case

CHILDHOOD DIABETES MELLITUS

          Diabetes means excess urination. Mellitus means – honey.

True story:-

            5yrs old girl who walks on rope (Tamil : Kazhai Koothadigal) belongs to a family that lives on performing road side acrobatics to earn their livehood. One day she fell down from rope-walking & be-came unconscious (coma). I examined her and could not find out the cause. First-of-all whether she became unconscious due to fall or she fell down because she was unconscious even while walking on the rope. Generally we are tempted to think that when she fell on the ground from a height of 15 feet, she would have suffured a blunt head injury & became comatose.

EXAMINATION:-

              Partient was totally unconscious. Reflaxes normal. Pupils normal. Heart normal. Respiration hurried. She had a distended urinary bladder. A syringe with a needle was poked into the bladder to remove some urine for examination. Benedict’s test done in the ward in 5minutes showed brick-red colour (high quantity sugar in urine). Later blood sample taken showed 700mg / 100ml. Simply insulin with isolyte p IV drip given in a modified method & 4^th hourly IM injection given for 1day. Patient regained consciousness in 12hours. Thereafter 4^th hourly subcutaneous insulin injection given as per urine test result, later tapered to 2doses of injection daily & case discharged after 3days with advice to continue insulin injection lifelong.

COMMENTS:-

         This is a case of Jnvenile diabetes can present in various ways including Coma.

GESTATIONAL DIABETES:-

          This is stress induced diabetes in certain women where stress is applicable to pregnancy, & placental hormones which blocks insulin action from pancreas.

  CONGENITAL DIABETES MELLITUS:-

          At birth, new born baby may manifest diabetes in various ways, mainly as fits. The cause is mainly genetic, but other causes included maternal diabetes. Beta cells of pancreas  secrete insulin. In some cases Anti-insulin antibodies prevent insulin to act. Sometimes beta cells are destroyed by some auto-immune mechanism. These babies are treated by insulin injection, till their condition is stable. Some of them may become Juvenile diabetes which is insulin dependent lifelong.

 HEADINGS FOR CONSIDERATION:-

1.      மதியை மயக்கும் இனிப்புக்கு பிறந்த இளம் குழந்தையும் விதிவிலக்கல்ல

2.     டயபடீஸ் என்னும் காலன் குழந்தைகளையும் துரத்தும்

3.      இனிப்பான பாதிப்பு

கசப்பான முடிவு

4.      இனிய வாழ்க்கையை இடிக்கும் இனிப்பு வியாதி

5.      இனிப்பில் உள்ள இன்பமும் துன்பமும்

6.      அதிக தாகம், அதிகம் சாப்பிடுதல், அதிக சிறுநீர் கழிப்பு

இவைதான் சர்க்கரை நோயின் அறிகுறிகள்