Which symptom strongly suggests diabetic ketoacidosis in a child with new-onset diabetes?

• A. Fever and cough.
• B. Weight gain and swelling.
• C. Abdominal pain with constipation.
• D. Polyuria, polydipsia, weight loss, dehydration, abdominal pain, and possibly fruity breath.

Answer: (D)

Diabetic ketoacidosis presents in children with new-onset type 1 diabetes as a picture of dehydration from osmotic diuresis, plus the metabolic effects of insulin deficiency. The key signs are polyuria and polydipsia from high blood glucose, weight loss from the body burning fat and muscle for energy, and dehydration. Abdominal pain is a common accompanying symptom in DKA, and fruity breath can occur due to acetone produced when fats are broken down. Taken together, this cluster points strongly to DKA and the urgent need for evaluation and treatment.

The other options don’t fit this urgent metabolic picture: fever and cough more likely suggest infection; weight gain and swelling point toward fluid overload or nephrotic syndrome; abdominal pain with constipation is not characteristic of the acute metabolic derangements seen in DKA.