BRIEF CASE HISTORY
A 12-year-old girl presents with a short history of polyuria, polydipsia and weight loss. There is no past medical history of note, but there is a strong family history of diabetes on her father’s side. She is clinically well and not dehydrated. Her height is 148 cm (50th centile) and weight 35 kg (25th centile). Her blood pressure is within normal limits for her age. Initial investigations are as follows.
Random blood glucose 24.2 mmol/l (435.6mg/dL)
Venous blood gas pH 7.34
Base excess 0.2
Bicarbonate 25.3 mmol/l
pCO2 6.0 kPa (45 mmHg)
Electrolytes Sodium 137 mmol/l
Potassium 3.9 mmol/l
Urea 3.5 mmol/l (21 mg/dL)
Creatinine 54 mmol/l (0.6mg/dL)
HbA1C 14.1%
Urinalysis Glycosuria, no ketonuria
Islet cell antibodies Negative
(a) What is the most likely diagnosis?
Type 2 diabetes
Diabetes insipidus
Type 1 diabetes
Maturity onset diabetes of the young (MODY)
(b) What would be the most useful test to establish the
diagnosis?
Oral glucose-tolerance test
Water-deprivation test
Molecular genetic analysis
Glutamic acid decarboxylase (GAD) antibodies
(c) What would be the most appropriate treatment at presentation in this girl?
Oral hypoglycaemic drug
Diet modification
Intravenous insulin and intravenous fluids
Subcutaneous insulin
None of above
Check correct answers at
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Check correct answers at
https://pediatricmcqsseqsbank.blogspot.com/2020/04/answers-to-case-study-can-you-diagnose.html
