Anzeige
Erschienen in:
03.02.2022 | Clinical Quiz
An adolescent with newly diagnosed diabetes mellitus presenting with edema: Answers
Erschienen in: Pediatric Nephrology | Ausgabe 8/2022
Einloggen, um Zugang zu erhaltenExcerpt
1.
What is the most likely diagnosis?
Insulin edema is the most likely diagnosis for this patient given the rapid onset of generalized edema following the initiation of an insulin regimen.
2.
What are alternative diagnoses to consider?
Alternative conditions that may initially present with generalized edema and weight gain include congestive heart failure, hepatic disease, and nephrotic syndrome. Other causes of volume overload must be excluded before making a diagnosis of insulin edema. In this case, there were no signs on physical exam to suggest cardiac or hepatic disease. Nephrotic syndrome was ruled out as the patient did not have proteinuria.
3.
What is the treatment of this condition?
Conservative treatment is recommended with salt and fluid restriction and the use of diuretics as needed. Most reported cases were noted to self-resolve within a few days to a few weeks. Our patient continued to have edema at follow-up with more tightness in her legs and an additional weight gain of 5 kg (69 kg, 83rd percentile, z-score up to 0.96). Although this might be attributed to expected weight gain from insulin treatment, we did not have previous growth charts to compare with her weight before diagnosis.