Transient diabetes in infancy.

Ann C. was admitted to hospital on June 26, 1953, at the age of I month. She was the third child of healthy parents and was born at full term following a normal delivery. No abnormality had been noted at birth and the birth weight was 6 lb. 2 oz. There was no family history of diabetes. She was breast fed for three weeks and then weaned on to feeds of full-cream National dried milk. For a week before admission she had seemed rather cross but she had taken her feeds well. There had been no vomiting, she had been passing formed yellow stools and there had been no polyuria. On the evening of admission her mother noticed that 'her head seemed to have sunk in at the top' and that her colour seemed poor. On admission she weighed 6 lb. 2 oz. (expected weight 7 lb. 6oz.). She was pale, wasted and grossly dehydrated, the most striking feature being the deep depression of the anterior fontanelle. A small boil was present on the left thigh but no other septic lesions were visible and no other abnormal physical signs were present on systemic examination. In view of the severe degree of dehydration intravenous fluid therapy was started imnediately, beginning with half-strength plasma (diluted with Hartmann's solution) of which 300 ml. was given in the first eight hours. This was followed by N/5 saline with 5%0 glucose, 425 ml. being given over the next 15 hours. Thus the total parenteral fluid in 23 hours was 725 ml. based on a requirement of 100 ml. per pound of expected body weight, dehydration being assessed at more than 10°o. Towards the end of this period slight oedena of the eyelids and of the sacral region was noted and 19 hours after the start of the intravenous infusion she had a generalized convulsion lasting for a few minutes. Two further convulsions occurred an hour later while she was being examined. In each of these there was stiffening of the body, arching of the back and a brief period of apnoea. Apart from the slight oedema there were no abnormal findings. The anterior fontanelle was now of normal tension and there was no stiffness of the neck. Lumbar puncture was performed and bloodstained fluid under low pressure was obtained. She was sedated with chloral and, although there was no clear evidence of infection, it was considered that the initial dehydration and the subsequent convulsions were probably due to infection and treatment was started with penicillin (400,000 u. daily) and steptomycin (120 mg. daily). The baby's subsequent progress was uneventful. She fed well, gained weight steadily and convulsions did not recur. She was discharged from hospital after seven weeks, having gained over 3 lb. in weight (Fig. 1).