title: [Severe ketoacidosis because of delayed diagnosis of diabetes in children. 4 cases to alert physicians].
abstract: BACKGROUND
  In France, 48% of children with insulin-dependent diabetes mellitus (IDDM) are seen for the first time at the stage of keto-acidosis (DKA), a figure far higher than in other countries. The four consecutive cases reported in this paper suggest that severity at presentation is directly related to the delay of diagnosis.
  
  
  METHODS
  All children, aged 6 to 11, presented with severe clinical and metabolic conditions: coma, hemodynamic failure, severe dehydration and acidosis (pH = 6.86 to 7.06). However, clinical symptoms were a present from 2 to 4 months, parents did not worry about them. Family practitioners visited 2-21 days before admission failed to immediately make the diagnosis of IDDM. True DKA was however present in all cases 48 hours prior to admission.
  
  
  CONCLUSIONS
  Earlier diagnosis of IDDM in children is necessary to reduce morbidity and mortality of DKA. General practitioners, pediatricians and emergency care practitioners must be made fully aware to consider diabetes in children and to use more extensively glucose-tests based on urine and blood strips.
authors.affiliation: Service d'endocrinologie et de diabétologie, hôpital Robert-Debré, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Blanc
authors.forename: M
authors.initials: M
authors.lastname: Polak
authors.forename: P
authors.initials: P
authors.lastname: Czernichow
authors.forename: N
authors.initials: N
authors.lastname: Tubiana-Rufi
mesh_terms: D002648:Child; D003681:Dehydration / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis*; D003926:Diabetic Coma / Q000209:etiology; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003951:Diagnostic Errors; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D013997:Time Factors
vernacular_title: Acidocétose sévère par retard au diagnostic de diabète chez l'enfant. Quatre observations pour alerter les médecins.