Child death related to insulin omission by mother

Area of Science:

• Pediatric Endocrinology
• Forensic Pathology
• Child Welfare

Background:

• A 4-year-old child with a 3-year history of insulin-dependent diabetes mellitus (IDDM) presented with persistently poor glycemic control.
• The child had multiple hospital admissions and monthly clinic visits, indicating ongoing medical management challenges.

Purpose of the Study:

• To investigate the circumstances and pathological findings in a fatal case of pediatric IDDM potentially linked to neglect.
• To determine the contributing factors to the child's death and assess the role of parental care and disease management.

Main Methods:

• Autopsy examination to identify pathological changes.
• Laboratory analysis of vitreous fluid for glucose and ketone levels.
• Review of the child's medical history and the circumstances surrounding her death.

Main Results:

• Autopsy revealed a fatty liver and absence of beta cells in pancreatic islets.
• Laboratory findings included ketoacidosis, ketonuria, glycosuria, and elevated vitreous glucose and ketones.
• Evidence suggested the mother's omission of insulin injections and general neglect, with the mother found intoxicated at the time of discovery.

Conclusions:

• The case highlights a fatal outcome of poorly controlled pediatric IDDM, strongly associated with severe parental neglect and potential child abuse.
• This case underscores the critical importance of consistent insulin therapy, diligent glycemic monitoring, and adequate parental supervision in managing childhood diabetes.