THE CLINICAL CASE The parents of a one-month old boy brought their child to the outpatient clinic at Anjo Kosei Hospital, where I was just starting my senior residency in the Department of Pediatrics. The infant had been vomiting since the previous day and his breathing was labored. The boy weighed just over 7 pounds. He had lost approximately half a pound over the last seven days. The child was very sick due to severe dehydration, and he had an uncompensated metabolic acidosis (pH 6.980, BE-25.5). Additional laboratory testing revealed hyperglycemia (glucose = 706 mg/dL) and ketosis (total ketone bodies = 13750 µmol/L), which suggested diabetic ketoacidosis.

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