Examination
Vitals
- Heart rate: 98 beats/min
- Temperature: 37.8°C
- Oxygen saturation: 95%
- Respiratory rate: 28 breaths/min
General
- Pale
- Sleepy and hypotonic
- Weight: 5 kg (< -3 SD for age)
- Cervical adenopathy (enlargement of the lymph nodes)
Cardiovascular
- Normal heart sounds
- All pulses present
Respiratory
- Good bilateral air entry
- No crackling sound on the lungs or wheezing
Abdomen
- Not distended
- Enlarged spleen
- Bowel sounds present
Neurological
- Normal pupillary reflexes
- Opens his eyes when feet are stimulated
- Moderate hyper-reflexia (exaggeration of reflexes) on upper and lower limbs
- No sphincter disorder
Dermatological
- Diffuse lesions of atopic dermatitis
- No sign of local infection
- No purpura (a small hemorrhage in the skin)
- Persistence of skin folds after pinching
Follow-up clinical examinations
At admission, Keran was immediately perfused with crystalloids. Urinalysis revealed high urine glucose and ketone levels. Type I diabetes mellitus was diagnosed. Insulin therapy was started intravenously. After a few days, intravenous insulin therapy was changed to basal-bolus insulin regimen. Physicians noted persistence of watery diarrhoea and absence of weight gain. Parenteral nutrition was required. Eczematous rash also persisted in spite of appropriate local treatments.
