Friday, January 11, 2008

T.G.I.F.

NewFNP loves her Fridays off. A little hiking, a little Bloomingdales sale to spend birthday 2006's gift certificate, a little Cosby Show rerun*. OK, that part is not so great but newFNP is one of the few remaining people who do not have cable so she is willing to indulge in a little retro-TV for a half hour.

She has spent a fair amount of her free time today, however, wondering what happened with a kid she sent to the ED on Wednesday.

NewFNP is generally so overwhelmed with type 2 diabetics that she had almost forgotten that type 1 diabetes existed as well. She even expects to diagnose her pediatric patients with type 2, given the degree to which she encounters the consumption of Hot Cheetos, Gatorade, and whole milk in her patients, as well as the prevalence with which she notes acanthosis nigricans, abdominal striae and hidden penises on physical exam.

However, newFNP would be remiss if she forgot that those wacky type 2 patients account for only 90% of diabetes diagnoses. She is fairly sure that she caught a kid in the early stages of Type 1 this week.

What a lousy 10% to be a part of!

This normal weight twelve year old boy -- whose well-child visit and urine dip were unremarkable a mere six months earlier -- came to our clinic with the chief complaint of abdominal pain. NewFNP's list of differentials includes things like appendicitis, AGE, UTI, nephrolithiasis and post-Winter Break school avoidance. As a general screening tool, newFNP has impressed upon her MA the importance of obtaining a urine dip on all of her tummy ache complaints and her MA never fails her in regards to this task.

Well, imagine newFNP's surprise when this kid's urine was chock-a-block full of glucose and ketones! When newFNP checked his fingerstick glucose, it was 313 and this was not a kid who had fed at the fast food trough prior to his visit. He had lost 3 pounds since his last well-child visit. He didn't look bad, just a little tired. He didn't smell ketotic and his breathing was normal.

NewFNP hasn't seen type 1 diabetes since she was working as an RN in her training hospital. She hasn't diagnosed it before and she was not sure if this kid's abdominal pain had anything to do with his diagnosis. Well, as it turns out, acute abdominal pain is a common presenting symptom of type 1 diabetes. Huh!

NewFNP's clinic has nothing - no RN's, no health educators, no nothing. Therefore, some quick education with the kid and parent about newFNP diagnostic suspicions and off to the ED. NewFNP is hopeful that the patient will bring back such important paperwork as c-peptide test results, discharge instructions and the name of his endocrinologist.

And if he comes back in tomorrow, newFNP will be waiting there for him at seven-fucking-thirty. She will make every effort to be pleasant, but it does, frankly, seem a stretch.

* In this episode, Rudy gets sent home by the school nurse when she gets her first period and Claire wants to have something called "Woman's Day" with her. Apparantly, Lisa Bonet and the other daughter - Vanessa, if memory serves - both had Woman's Days and Vanessa's involved a trip to the Plaza Hotel for brunch. NewFNP went to the Plaza to celebrate her her 30th birthday, not her frigging menarche, a day which she still curses! Those crazy Huxtables!

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Ana Maria said...
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