Peripheral edema in a child with insulin-dependent diabetes mellitus

The report details the case of a 14-year-old boy who had been experiencing polyuria, polydipsia, excessive fatigue, and weight loss for the past six months and presented with diabetic ketoacidosis (DKA). Upon examination, he appeared dehydrated and malnourished, with a heart rate of 92 beats per minute, respiratory rate of 24 breaths per minute, and blood pressure of 110/70 mmHg. The patient received treatment according to the local DKA guidelines, including one fluid bolus of normal saline on admission. His initial blood ketones were 5.4 mmol/l, and pH was 6.9. The ketoacidosis resolved after 48 h, and he was changed to subcutaneous insulin, comprising a basal bolus of insulin glargine and quick-acting insulin novo rapid. The patient stayed at the hospital for 14 days due to diagnosis-related anxiety and difficulty delivering diabetes education to the young person and his family.

The patient developed a non-tender and bilateral pitting edema to the lower legs on day 5 of his admission but displayed no other features of renal, cardiac, or hepatic causes of his edema and did not have periorbital edema. His urine was negative for proteinuria and showed normal renal and liver function, including albumin level and inflammatory markers. His initial screening blood tests were positive for anti-glutamic acid decarboxylase and anti-islet cell antibodies, thyroid function tests were normal, and thyroid peroxidase antibodies were negative.

The patient did not require any active management, and his edema gradually improved with an elevation of the legs. The patient received a discharge from the hospital after nine days, with only minimal residual edema. After four weeks in the clinic, he showed a 7.45 kg weight gain and an improvement in BMI with no evidence of edema.

Zamir I, Zubairi A, Cainer A, Jagwani H. Peripheral edema in a child with a new diagnosis of insulin-dependent diabetes mellitus. Indian J Case Reports. 2023;9(1):9-10.