A 2.5-year-old boy with a history of fever a year ago presented with irritability, vomiting bilious and nauseated for 24 hours.
In the emergency room, there is regular general irritable state, semi-humid mucous membranes, cutaneous-mucosal dryness, normal capillary refill, peripheral pulses present.
Blurred, depressible and painless abdomen, temperature: 38.9oC; respiratory rate: 40 per minute; heart rate: 140 per minute; blood pressure: 100/50; 98% satur Ab2:
Complete blood count was performed: white blood cells 23 700 per mm3, C 4/ S 74/ E 1/ L 17/ M 4; platelets 343 000 per mm3, hematocrit 38%; EAB 7.30/ 42.2/ 20.5 / dl
With a diagnosis of diabetic debut, expansion with Ringer's solution is indicated, followed by intravenous plan at 3000 ml/m2/day and current insulin 0.1 U/kg intramuscular.
She's in the room.
There we found post-expansion glycemia and insulin of 241 mg/dl, with new EAB 7.35/43.3/18.8/ -5.9.
Hyperglycemia without secondary ketosis was observed.
The mother was questioned: a history of hospitalization one year ago with vomiting and bleeding of unknown and self-limiting etiology.
Let us examine the exogenous contribution of insulin.
Bloody stools appear; an abdominal x-ray is performed on the foot and consultation with surgery.
1.
A diagnosis of acute intestinal obstruction was made.
Malrotation and intestinal volvulus without necrosis were found.
Ladd's operation was performed (gut return, adhesion release, duodenal frame rectification, ablactation and colon localization in left hemiabmen and right ileum and ileum in hemiabdomen).
1.
After surgery a left pneumonia develops; hemocultives and peritoneal fluid culture are negative.
She received 7 days of intravenous antibiotics.
During hospitalization (10 days) and follow-up, blood glucose levels are below 150 mg/dl with normal glycosuria.
On the 10th day of hospitalization glycated hemoglobin was requested: 6.9% (normal value: up to 6.4%) and insulinemia: < 0.6 mU/L (normal value 5-15 mU/L).
