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January 30, 2005

Hyperglycemia and DKA, Other

Question from Gadsden, Alabama, USA:

My friend's eight year old granddaughter just passed away. She had never been diagnosed with diabetes. They thought she had a virus, took her to a local Emergency Room (ER). She had been having headaches, throwing up, just not feeling good, but was drinking a lot of fluids. When she got to the ER, they started fluids for dehydration and had the mother sign a form that stated that pushing fluids could possible cause swelling, no other explanations. Tests cam back showing her blood sugar level was 500 mg/dl [27.8 mmol/L]. The fluids were already being administered and she started having extreme headaches, holding her head and crying to her mother that her head hurt so bad. Long story shortened, the fluids went to her brain and caused swelling. They airlifted her to Children's Hospital in Birmingham, Alabama, but it was too late, When they did the CAT scan on her, there were no brain waves. This was a child that had no prior problems, was very active in cheerleading, gymnastics, softball, etc. I know NOTHING will bring this child back to these grieving parents, but they have another daughter who is four years old. Today is the first day after the funeral and they will be taking her to be checked. What could we have looked for? How could we have known? What do we tell other parents to be aware of? These wonderful parents of these two little girls didn't know she had diabetes and it had never shown up on any test at any doctor office visits.


Deepest, deepest thoughts on the loss of your friends’ grandchild. An important point for other families reading this message is that of the need of deep respect for diabetic ketoacidosis (DKA).

Indeed, based on your description, it seems the little girl had a serious consequence of poorly controlled and rapidly worsening, and fulminant diabetes called DKA. The family may wish to review the Symptoms of Diabetes on this web site to reflect on what they think they may have overlooked in the days and weeks leading up to the development of DKA, and thus allow them to be on the lookout for similar symptoms.

With higher and higher blood sugars, there is increased urination to help excrete the extra sugar. This increased urination leads to degrees of dehydration, sometimes severe. Typically, there is increased thirst to help overcome the dehydration. Unfortunately, most of the time, people will say “Of course they are urinating more; look how much they’re drinking!” But, in diabetes, the thirst is to compensate for the urination. But, the higher sugar levels in the blood also eventually lead to a process whereby the body produces a series of chemicals (called ketones and acids). When these accumulate, they can change the level of consciousness, cause headaches, nausea, vomiting and other non-specific symptoms that can look like “the flu.” But, the flu commonly is associated with fever. DKA typically does not have fever. It typically is associated with change in breathing patterns, and brain swelling.

The treatment for DKA first must focus on the rehydration to get the blood flowing well to all the most important organs. But, there is the hitch: rapid correction or too much fluid increases the risk of brain swelling which, as tragic as you’ve seen, can be fatal.

Perhaps your friends need to have a sit-down discussion with their family doctor in a few weeks to ventilate, review, and perhaps review the autopsy, which I hope was done so as to exclude no unexpected issues.