Type 1 diabetes mellitus is suspected in a child. Which clinical manifestation may be present?

Choice A reason:

Extracellular hyperglycemia refers to high blood sugar levels outside the cells. While hyperglycemia is a common feature of diabetic ketoacidosis (DKA), it is not the direct cause of the condition. DKA occurs when the body cannot use glucose for energy due to a lack of insulin, leading to the breakdown of fat and protein for energy, which produces ketones and causes acidosis.

Choice B Reason:

Hypoglycemia, or low blood sugar, is not associated with diabetic ketoacidosis. In fact, DKA is characterized by high blood sugar levels. Hypoglycemia is a separate condition that can occur in individuals with diabetes, particularly if they take too much insulin or skip meals.

Choice C Reason:

The use of fat and protein as an energy source is the primary mechanism behind diabetic ketoacidosis. When insulin is deficient, the body cannot utilize glucose for energy. As a result, it breaks down fat and protein to produce energy. This process generates ketones, which are acidic and lead to the development of ketoacidosis.

Choice D Reason:

Increased cellular metabolism of glucose is not related to diabetic ketoacidosis. In DKA, the problem is that cells cannot use glucose effectively due to a lack of insulin. Instead, the body resorts to breaking down fat and protein for energy, leading to the production of ketones and acidosis.

The correct answer is

A. Unable to roll over back to front

B. Head lag

C. Feeding difficulties

D. Floppy posture

E. Arms are stiff

F. Does not smile

G. Unable to sit without support

H. Irritable and cries often

I. Unable to pass an object between hands

Choice A reason

Unable to roll over back to front: At 3 months, infants typically start to develop the ability to roll over from their stomach to their back. Rolling over from back to front usually occurs later, around 4 to 6 months. However, the inability to roll over at all by 3 months could indicate developmental delays or muscle weakness, which requires follow-up.

Choice B Reason

Head lag: By 3 months, infants should have enough neck muscle strength to hold their head up when pulled to a sitting position. Persistent head lag at this age can be a sign of developmental delay or neuromuscular disorders, necessitating further evaluation.

Choice C Reason

Feeding difficulties: Infants should be able to suck and swallow effectively by 3 months. Feeding difficulties can lead to inadequate nutrition and growth, and may indicate underlying issues such as gastrointestinal problems or neurological disorders. This requires prompt attention and intervention.

Choice D Reason

Floppy posture: A 3-month-old should start to show more control over their body movements and have a more stable posture. Floppy posture, also known as hypotonia, can be a sign of various conditions, including genetic disorders, muscle diseases, or central nervous system issues. It is important to investigate the cause of hypotonia.

Choice E Reason

Arms are stiff: Stiffness in the arms, or hypertonia, can indicate neurological problems such as cerebral palsy or other motor disorders. It is crucial to assess the underlying cause of increased muscle tone and provide appropriate interventions.

Choice F Reason

Does not smile: Social smiling typically begins around 6 to 8 weeks of age. If a 3-month-old does not smile, it could be a sign of developmental delay, visual impairment, or other social and emotional issues. This warrants further assessment to determine the cause.

Choice G Reason

Unable to sit without support: While sitting without support is not expected until around 6 months, the inability to show any signs of trying to sit or maintain a sitting position with support at 3 months could indicate developmental delays. This should be monitored and addressed if necessary.

Choice H Reason

Irritable and cries often: Excessive irritability and frequent crying can be signs of discomfort, pain, or underlying medical conditions such as infections, gastrointestinal issues, or neurological problems. It is important to identify and address the cause of the infant’s distress.

Choice I Reason

Unable to pass an object between hands: By 3 months, infants should start to develop hand-eye coordination and the ability to grasp objects. The inability to pass an object between hands may indicate developmental delays or motor skill issues, which require further evaluation.