May 19, 2008
Diagnosis and Symptoms
Question from Holland, Michigan, USA:
My 13-year-old son recently had appendicitis and an appendectomy. He is not overweight, 5 feet, 7 inches, 136 pounds. He presented in the Emergency Room with right lower quadrant pain, vomiting four times in four hours, no fever, and no food for five hours. He had eaten a big lunch. His blood glucose was 126 mg/dl [7.0 mmol/L] and he had large ketones in his urine. He had surgery at 9 p.m. and had lactated ringers running in an I.V. all night at 125. In the morning, his glucose was 186 mg/dl [10.3 mmol/L] fasting. I checked his urine and his glucose at home two days later. His urine was negative and his fasting blood sugar was 80 mg/dl [4.4 mmol/L]. I am worried that he is developing diabetes and the stress of the appendicitis brought this out. My pediatrician thinks it is just stress induced hyperglycemia, but would he have ketones in his urine with that?
Answer:
I agree with your pediatrician. Stress is the likely cause. The illness caused him to starve and the ketones were a product of that. You apparently know the signs of diabetes so watch. Thirst and increased urine should send you back to the pediatrician, but really, there is a lot of data on stress in high blood glucose that almost never is diabetes.
LD
