FOUR YEARS OLD CHILD WITH

INCREASED FREQUENCY OF
MICTURATION
PRESENTED BY..
DR. ZAKIA FERDAUSI KHAN
Particulars of the patient
Name : Master Shafat Al Mukammel
Age : 4 Years
Sex : Male
Present address : Rd # 4, House # 236,
Mohammadia housing society,
Mohammadpur.
Date of admission : 20/11/2016.
Date of discharge : 27/11/2016
Chief Complaints:
Excessive thirst for 1 month.
Increased frequency of Micturition for 7 days.

Presenting illness:
According to the statement of the Patients mother he was reasonably well 1
month back. Then he developed gradually increasing thirst predominantly for
milk.His mother also complaints of gradual loss of appetite & weight which was
not significant. He also developed cold & cough 2 weeks ago for which he received
Medication but refused to take it & since 1 week ago he developed Increase
frequency of micturition .His bowel habit is normal.

Past illness:
Nothing significant.

Birth History:
Antenatal History : Un eventful
Natal History : Term LUC &
wt : 3.25 kg.
Post natal History : uneventful.
Development History:
Appropriate for age.

Immunization:
Immunized according to EPI. Schedule.

Travel History:
Nothing significant.

Family History:
4th Issue, Non consanguineous parents.
Sister has Diabetic Insipidus.
Father is diabetic 1 year.

Social & Personal History:

Middle Socioeconomic class.

Drug History:
Syp. Salbutamol
Syp. Cefixime
General Examination:
Appearance: Ill looking
Anemia: Absent
Jaundice: Absent
Cyanosis: Absent
Clubbing: Absent
Koilonichia: Absent
Ieukonichia: Absent
Oedema: Absent
Dehydration: Absent
GENERAL EXAMINATION(CONT..)

Pulse: 86b/min
BP: 110/60 mmhg
Temp: 98
Heart: Rate: 110b/min
Resp rate:36br/min
Examination of ear, Nose, Throat: Nothing Significant.
Examination of eye: Nothing Significant
Systemic Examination:
Gastro intestinal System:-
Per abdominal examination
a)Inspection:-
Shape of abdomen is normal.
Umbilicus centrally Placed.
There is no engorged vain, visible pulsation No abdominal scar.
b)Palpation:-
Abdomen: Soft. Non tende, Temperature Normal, There is no
organomegally.
c) percussion:-
Percussion note: Normal.
d) Auscultation:-
Bowel Sound Present.
Respiratory System:
Vesicular with normal intensity with normal pattern.

Cardio vascular System:

S1+S2+O

Genito Urinary System:

Nothing significant.

Locomotors System:
Nothing Significant.

Nervous System:
General Intellectual functions. Motor function & Reflexes: intact.
Cerebellar Punction, Sensory, evanial nerves, Gait: Not evaluates

Type I Diabetes mellitus.

PROVISIONAL
DIAGNOSIS:

Type1 Diabetes Mellitus.

salient feature:
Master safat Ali Mukammel 4 years old muslim male child hailing
from mohammedpur was admitted in this hospital on 20.11.2016
with the complaints of excessive thirst for 1 month and increased
frequency of micturation for 7 days and with weight
loss.According to the satement of patients mother he was
reasonably well 7 days back then he developed frequency of
micturation and gradually increasing thrist.he has history of
weight loss also.
he has no fever and no significant past history.his antenatal
period was uneventful.he was delivered by LUCS and his weight
was 3.25 kg.his development was appropriate for age.he was
immunized according to EPI.his sister has diabetes.he has no
jaundice,aneamia or cyanosis.his systemic examination also
reveals nothing significant.on abdominal examination shape of
abdomen is normal,umbilicus centrally placed.on palpation no
organomegaly was there.
 Investigation Investigation Investigation
CBC
Hb 14.20gm/dL 20/11/2016
ESR 2 mm in 1st hour
Total count
WBC 16.59 X 10 9/L
RBC 5.43 X 10 12/L
Platelets 250 X 10 9/L
Differential count
Neutrophil 42 %
Lymphocytic 44 %
Eosimophil 12 %
Hematocrit 38 %
RDW-SD (FF) 33 fL
PBF
RBS Micro cytic
Hypo chromic
WBS Mature
Platelet Normal
 Investigation Interpretation

Serum 21/11/2016 20/11/2016

Electrolytes
Sodium 135 mmol/l 136 mmol/l
Potassium 3.6 mmo l/l 3.7 mmol/l
Chloride 102 mmo l/l 100 mmol/l
TCO2 25 mmo l/l 24 mmol/l

Random 20.5 mmol/l 30.5 mmol/l

Blood glucose

Cores pending
Urine (+ + + +)
Sugar
ketonebody:
++
TREATMENT OF DKA

4c
Correction of dehyrahration
NS follwed by dextrose
Regular insulin
Coorection of acidosis
Correction of infection

Follow up
Blood sugar,