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July 31, 2002

Hyperglycemia and DKA

Question from Detroit, Michigan, USA:

Two years ago, our son born with pulmonary stenosis and bilateral renal thrombosis, which resolved within the first year, started to complain of severe chest pains which lead us to his cardiologist for tests. All tests indicated nothing had changed, and the doctor could not account what was causing his chest pains, other than "growing" pains. Within a week of the episode of chest pains, he saw a flash of light and lost his vision for a moment. So, we took him to both a pediatric eye doctor and neurologist. The eye doctor thought he had a migraine. The neurologist did a series of tests on him, and, as we were awaiting the results of the EEG, he had a bedwetting. This was not normal for him, and he was urinating several times during the night. We took him into the pediatrician, who diagnosed him with diabetes since he had sugar levels which exceeded their office meter. He was admitted to our local children's hospital with sugar levels in the 600s [mg/dl, 33.3 mmol/L], and while he was in the hospital, the neurologist called to inform us that his EEG was abnormal. It showed unusual activity, commonly seen with abnormal metabolic activity. We told her that our son had been diagnosed with diabetes, which she said would answer her findings. It's been two years since we had been told about our son. Our question to you has yet to be answered by any of his speciality doctors. Why does our son still experience chest pains when his sugars hit 250 mg/dl [13.9 mmol/L] or higher? Yes, it is an indicator for us, as are his migraines, that his sugar is elevated, but we are concerned as to the cause and any long term impact on his heart (he is within 85% of his target range). His cardiologist said he doesn't have an answer; he can just tell us his heart looks good from all of his tests. Have you come across any other patients who have diabete and cardiac problems? Any information would be greatly appreciated.

Answer:

There have indeed been occasional accounts of typical cardiac pain adults in association with hyperglycemia, but in whom there has been no formal evidence of coronary insufficiency. I have not heard of nor been able to discover any reports of similar occurrences in childhood.

Sometimes children who are moving toward DKA [diabetic ketoacidosis] will complain of discomfort in the chest, and this perhaps what is happening with your son.

It would be sensible to test for ketones in the serum or urine if this recurs and then consult with your son’s diabetes team as to how to resolve the situation.

DOB