Infant diabetic ketoacidosis in the emergency department

We present the case of an infant brought to the emergency department with complaints commonly associated with a typical childhood illness. Surprisingly, he was found to have diabetes mellitus with ketoacidosis. The usual symptoms of polyuria, polydipsia, and weight loss attributed to diabetes mellitus were not observed. A fruity smell on his breath led to appropriate laboratory tests and ultimately to the correct diagnosis. We review appropriate management of infantile diabetic ketoacidosis, emphasizing the importance of considering diabetes mellitus and ketoacidosis in infants admitted to the emergency department with common complaints such as vomiting and irritability. As in our case, the clinical finding of a fruity breath smell can be an important factor in diagnosis.