SEVERE KETOACIDOSIS REVEALING INSULIN-DEP ENDENT DIABETES IN CHILDREN- A CALL FOR MEDICAL ALERTNESS

Background. - In France, 48% of children with insulin-dependent mellit us (IDDM) are seen for the first time at the stage of keto-acidosis (D KA), a figure far higher than in other countries. The four consecutive cases reported in this paper suggest that severity at presentation is directly related to the delay of diagnosis. Case reports. - All child ren, aged 6 to 11, presented with severe clinical and metabolic condit ions: coma, hemodynamic failure, severe dehydration and acidosis (pH = 6.86 to 7.06). However, clinical symptoms were a present from 2 to 4 months, parents did not worry about them. Family practitioners visited 2-21 days before admission failed to immediately make the diagnosis o f IDDM. True DKA was however present in all cases 48 hours prior to ad mission. Conclusions. - Earlier diagnosis of IDDM in children is neces sary to reduce morbidity and mortality of DKA. General practitioners, pediatricians and emergency care practitioners must be made fully awar e to consider diabetes in children and use more extensively glucose-te sts based on urine and blood strips.