Hyperglycaemia, glycosuria and ketonuria may not be diabetes.

Diabetic ketoacidosis is a well recognised, important, but rare differential diagnosis of acute abdominal pain in children. We report a case highlighting the need for complete assessment of any child presenting with new-onset glycosuria, ketonuria and hyperglycaemia. Causes other than diabetes may rarely produce these findings. CASE REPORT A girl aged three years and ten months with a six-hour history of abdominal pain and vomiting was referred to the surgical team by a general practitioner. Past medical history included a diagnosis of non-specific abdominal pain at three years old. There was no significant family history nor recent illness in the family circle. On examination she was restless and thirsty, but apyrexic. There was no foetor or rash. She had grunting respiration with tachypnoea, but the lungs were clear on auscultation. Her abdomen was soft with mild generalised tenderness and no localised guarding or rebound in any quadrant. Urine dipstick analysis showed three pluses of ketones and three pluses ofglucose. Blood glucose was 16 mmol/L on ward testing. Further history suggested thirst earlier in the day and possibly some recent weight loss. With this history, and initial findings a paediatric medical opinion was sought regarding a diagnosis of diabetes mellitus. Laboratory blood glucose was 1 6.3mmol/L. Acid base balance was normal with a blood gas pH of 7.38, and base excess of-1 .Blood count, electrolytes, abdominal and chest radiographs were all normal. CRP was elevated at 88.9mg/L. On the basis of these results repeat abdominal examination was undertaken three hours after admission. At this time her temperature was 37.6C, again she had generalised abdominal tenderness, maximal in the lower abdomen now with associated guarding and rebound. A presumptive diagnosis of acute appendicitis was made and an exploratory laparotomy undertaken through a lower mid line incision. A perforated appendix was found along with pus in the peritoneal cavity. Appendicectomy and peritoneal lavage were performed. Postoperative recovery was uneventful, and she was discharged home on the third postoperative day. Subsequent random blood glucose was normal at 4.6mmol/L. Her HbAlc was normal while islet cell antibodies were negative. At review she was well, with no complaints or complications. DISCUSSION Rarely diabetic ketoacidosis may present with acute abdominal pain.' As this is an important diagnosis it is listed in most surgical and medical textbooks. The absence of any acid-base disturbance, ruled out the diagnosis of diabetic ketoacidosis in this little girl. No active infection could …