Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in new-onset type 1 diabetes (T1D). Supraventricular tachycardia (SVT), however, is a very rare complication of DKA. We present the case of a patient with new-onset T1D who presented with DKA. He received intravenous fluid resuscitation, insulin and potassium supplementation and subsequently developed SVT, confirmed on a 12-lead electrocardiograph despite a structurally normal heart. Vagal manoeuvres and adenosine failed to restore sinus rhythm, but flecainide was successful. We conclude that SVT can occur as a complication of DKA, including in new-onset T1D. Our case is the first of this phenomenon occurring in new-onset childhood diabetes, as the few prior documented cases had established diabetes. Furthermore, a combination of potassium derangement, hypophosphataemia and falling magnesium levels may have precipitated the event.

Background: Urinary tract infection (UTI) is a common reason for referral to the emergency department (ED) especially in unwell infants. Upper UTIs are particularly at risk of significant complications later in life. Rapid dipstick urinalysis and microscopy are often used in unwell children as a screening tool to guide early diagnosis and treatment. This study aims to evaluate the sensitivity of dipstick urinalysis and microscopy in the diagnosis of UTI. Methods: A retrospective review of children aged 16 years and below with positive urine culture (UC) over a 3-year period was done. The results of urine dipstick and microscopy were compared with the positive UC and sensitivities calculated. Results: Dipstick urinalysis and microscopy of 262 children were studied. Female-to -male ratio of 1.8:1. Median age was 0.79 (range: 0.02–15.95) years. The sensitivity of nitrite, blood, and leukocyte esterase (LE) were 0.54, 0.74, and 0.86 (95% confidence interval [CI] = 0.46–0.62, 0.68–0.80, and 0.82–0.91), respectively. The sensitivity of pyuria of ≥100 cells/mm 3 was 0.92 (95% CI = 0.89–0.95). The presence of any of the 3 dipstick parameters increased the sensitivity to 0.97 (95% CI = 0.95–0.99). The lowest sensitivity 0.49 (95% CI = 0.40–0.58) was found with combined positive LE and nitrite. There was a significant comparison between positive LE dipstick test and pyuria ( P = 0.000004). Conclusions: Dipstick urinalysis may not be reliable in ruling out UTI in children. However, considering both positive dipstick and pyuria will be more useful in making the diagnosis.

Case presentation The only child of consanguineous moroccan parents presented at 6 weeks of age with poor weight gain and prolonged jaundice. He was profoundly hypotonic and not yet smiling or fixing and following. Investigations revealed severe hepatic dysfunction, elevated lactates, hypoglycaemia and abnormal urine organic acids (consistent with mitochondrial dysfunction). Cranial ultrasound scan, ophthalmology and cardiology assessments were normal. Muscle biopsy was histologically normal and muscle mitochondrial respiratory chain complexes were normal. Liver biopsy showed cholestasis, lobular disarray and large droplet steatosis and decreased resp chain complexes I, II&III (combined) and IV activities. This pattern is suggestive of mitochondrial DNA (mtDNA) depletion. Hepatic mtDNA content was confirmed to be just 6% of expected normal mtDNA content. Genetic analysis showed homozygosity for a deletion in exon 4 of the MPV17 gene, a gene necessary in mtDNA replication. This gene is one of a number of genes, all involved in mtDNA replication or maintenance, that are associated with hepatocerebral mtDNA depletion syndromes, clinically sometimes known as Alpers syndrome. Despite normal muscle respiratory chain levels, mtDNA depletion was also present in muscle with just 25% of normal mtDNA content present. Unfortunately his clinical course continued to progress and he died at 7 months of age. Conclusion Hepato-cerebral depletion syndromes are heterogenous and may present at any age. They are rare but should be suspected with a clinical combination of neurological, hepatic and metabolic abnormalities. Timely diagnosis is very important as this diagnosis is an important factor in decision making around liver transplantation.