Cioci Anthony, Rudnick Chad, Ohanisian Levonti
Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL, 33431, USA.
Charles E. Schmidt College of Medicine, Florida Atlantic University, 5458 Town Center Road Suite 13, Boca Raton, FL, USA.
BMC Pediatr. 2019 Oct 30;19(1):395. doi: 10.1186/s12887-019-1785-z.
In the pediatric population, parental concern of recent onset frequent or large volume urination in young children is common.
A 2-year-old male with no significant past medical history and unremarkable family history was brought to his pediatrician by his mother who reports that the child had been "soaking through his diapers" for the previous two to 3 days. Mother states that patient has not had an appreciable change in the number of wet diapers per day, just the perceived weight/volume of each diaper. The patient's mother denied any recent illness, apparent abdominal pain, dysuria, or recent changes in his bowel movements. She similarly denied polydipsia, polyphagia, or gross hematuria in the patient. Patient's diet consists of eating a low carbohydrate with mostly high protein and fat diet that was similar to the paleo-type diet consumed by her and her husband. Meals over the recent days were even lower in carbohydrates than usual as the family was actively trying to consume healthier food options. On physical exam the child was found to be afebrile with a normal physical exam. A urine dipstick was performed and was positive for 2+ ketones and 1+ protein. Urine leukocytes and nitrites were negative, as was urinary glucose. A fingerstick blood glucose sample was 83 mg/dL. Based on the patient's physical examination, laboratory findings, and the history which revealed a very-low carbohydrate diet, a preliminary diagnosis of ketosis-induced polyuria was made. The patient's mother was advised to incorporate a greater portion of carbohydrates into her son's diet, with a follow-up scheduled for the following week. At the follow-up appointment the mother reports that she had continued the patient's carbohydrate intake and the excessive urine amount per wet diaper has not returned. Repeat urine dipstick confirmed the resolution of the ketonuria and proteinuria.
This case illustrates the inadvertent consequences that can occur when parents impose new fad diets on their young children. The recent increase in the popularity of fad diets makes the consideration of alternative diets important to review in the patient history and subsequently include in the differential diagnosis of polyuria.
在儿科人群中，家长对幼儿近期出现的频繁或大量排尿感到担忧是很常见的。
一名2岁男性，既往无重大病史，家族史无异常，其母亲带他去看儿科医生，母亲报告说孩子在过去两到三天一直“尿湿尿布”。母亲表示，患儿每天尿布湿透的次数没有明显变化，只是感觉每个尿布的重量/尿量增加了。患儿母亲否认近期患病、明显腹痛、排尿困难或近期排便习惯改变。她同样否认患儿有多饮、多食或肉眼血尿。患儿的饮食以低碳水化合物为主，主要是高蛋白和高脂肪饮食，类似于她和丈夫所食用的古式饮食。由于家人积极尝试选择更健康的食物，最近几天的饮食中碳水化合物含量比平时更低。体格检查发现患儿无发热，体格检查正常。进行了尿试纸检测，结果显示酮体2+、蛋白1+呈阳性。尿白细胞和亚硝酸盐呈阴性，尿糖也是阴性。指尖血糖样本为83mg/dL。根据患儿的体格检查、实验室检查结果以及显示极低碳水化合物饮食的病史，初步诊断为酮症性多尿。建议患儿母亲在儿子的饮食中增加更多碳水化合物，并安排下周进行随访。在随访预约中，母亲报告说她继续让患儿摄入碳水化合物，每个湿尿布的尿量过多的情况没有再出现。重复尿试纸检测证实酮尿症和蛋白尿已消失。
本病例说明了家长给幼儿强加新的时尚饮食时可能产生的意外后果。时尚饮食近来越来越流行，因此在患者病史中考虑替代饮食并将其纳入多尿的鉴别诊断很重要。
