Diagnosis of diabetes in an infant can be difficult and may be delayed if the findings are ascribed to another condition. A delay in diagnosis can result in significant morbidity and mortality.


Typical presentation in an infant:

(1) vomiting

(2) tachypnea

(3) dehydration

(4) anorexia

(5) tachycardia

(6) altered consciousness

(7) irritability

(8) polyuria and polydypsia (often go unrecognized)


Laboratory findings in diabetic ketoacidosis:

(1) large amounts of ketones in the urine (other conditions usually show small amounts)

(2) serum glucose > 300 mg/dL

(3) acidosis (serum bicarbonate < 15 mEq/L and pH < 7.3)


If the infant is not acutely ill then the following results indicate the present of diabetes:

(1) a random plasma glucose is > 200 mg/dL or

(2) fasting whole blood glucose > 120 mg/dL


Common misdiagnosis:

(1) acute gastroenteritis

(2) viral upper respiratory infection

(3) sepsis


Differential diagnosis for hyperglycemia and glucosuria:

(1) acute febrile illness

(2) epilepsy

(3) central nervous system infection


Differential diagnosis for ketonuria:

(1) persistent vomiting

(2) starvation

(3) inherited metabolic disorder


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