A 4-Year-Old Girl in Significant Distress

Alba Morales Pozzo, MD

Disclosures

March 05, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A previously healthy 4-year-old girl, who was delivered at normal gestation, developed frequent urination, excessive thirst, and new-onset enuresis 4 weeks prior to her presentation at an emergency department (ED) in a children's hospital. Her parents report that on the day of the ED visit, she appeared fatigued, irritable, and pale. The patient also described abdominal pain and has had seven to 10 episodes of emesis over the last 2 days.

The patient takes no medications at home and has no significant medical or surgical history. Her development has been normal to this point, and her vaccinations are up to date. Her family history is remarkable for type 2 diabetes mellitus in her maternal grandmother.

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