A child presents with polydipsia and polyuria. Which emergency complication must be considered?

• A. Dehydration
• B. Hyperosmolar Hyperglycemic State
• C. Hypoglycemia
• D. Diabetic Ketoacidosis

Answer: (D)

When a child presents with polydipsia and polyuria, think about significant hyperglycemia from new-onset type 1 diabetes. The emergency complication to consider is diabetic ketoacidosis. This develops when insulin is severely lacking, causing marked hyperglycemia with dehydration from osmotic diuresis and ketone production that leads to metabolic acidosis. It can progress quickly and become life-threatening if not recognized and treated promptly. Look for dehydration, rapid breathing, abdominal pain or vomiting, and possible fruity breath or mental status changes, along with lab signs of high glucose, low bicarbonate, an elevated anion gap, and positive ketones. Hyperosmolar hyperglycemic state is less common in children, and hypoglycemia is not the typical emergency in this presentation, though it remains dangerous in other contexts.