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Washington University Experience | VASCULAR | Herniation, uncal | 11A0 Case 11 History
Case 11 History ---- The patient is a 10 year old male with a one year history of poorly controlled type I diabetes who presented with a 24 hour history of nausea, vomiting and a diffuse headache. He was taken to an OSH where urine sugar was 4+ and acetone was present. He was treated with NPH insulin but became somnolent with ketoacidosis. Insulin was adjusted and fluids were administered. Two hours after admission the patient complained of headache and became combative. Five hours after admission he was found to be unresponsive with fixed, non-reactive pupils, bilateral Babinski signs, and bilateral papilledema; Mannitol and Decadron were given and the patient was transferred to SLCH. The patient remained comatose, developed diabetes insipidus and fever to 42°C, prompting Ampicillin treatment. He developed multifocal spike activity by EEG and received Dilantin. He remained without any clinical change and 48 hours after admission he developed a respiratory arrest; resuscitation was begun but he did not survive.
