[Vomiting: not a benign symptom in children with diabetes]

Two girls, 14 and 15 years old and known for several years with diabetes, came to the paediatric outpatients' clinic because they had been vomiting for 1-2 days. Laboratory tests revealed diabetic ketoacidosis. After administration of fluids and short-acting insulin, and sodium bicarbonate in one of the girls, the patients recovered, although one of them continued to have fluctuating glucose values. In most children, vomiting indicates benign gastro-enteritis and is therefore self-limiting. But in children with diabetes mellitus, vomiting can be more sinister because it could lead to, or be a symptom of, diabetic ketoacidosis. Even with normal blood glucose levels, severe metabolic disturbances are possible, and tests diagnosing diabetic ketoacidosis are recommended.