Severe anemia and massive proteinuria in a boy with diabetes mellitus: Questions

Excerpt

A 7-year-old boy with a diagnosis of type 1 diabetes mellitus (DM) for 2 years was admitted to the emergency department with weakness, pallor, and edema of the hands and feet. There was no change in the amount or color of urine. He denied fever or any finding that could be associated with infectious disease. He was using subcutaneous insulin and daily blood sugar follow-up was done regularly. It was learned that his parents had given three different formulas of ayurvedic medicine from India (Madhumeha Nivarin®, Punarnavasavam®, Jambavasava®) every day for 5 months in order to relieve type 1 DM. He was also taking 45 mg/day of oral zinc for 6 months. There was no kidney disease in the family. On physical examination, height was 124 cm (50–75 p), body weight 18 kg (10 p), blood pressure 100/50 mmHg (95th percentile 130/83 mmHg), and heart rate 114/min. He had pallor on conjunctiva and edema on lower extremities. Systemic examination did not reveal any additional pathology. Laboratory results are presented in Table 1. Peripheral blood smear revealed macrocytic erythrocytes without findings associated with hemolysis (Fig. 1).

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