Gangrene in an Infant Associated with Temporary Diabetes

Abstract

Gangrene and diabetes are both extremely rare in the first few weeks of life. Still more unusual are the cure of the gangrene and the complete disappearance of the diabetes. We propose in this paper first to place on record and discuss such a case, and secondly to review the recorded cases of diabetes in children under one year of age. She was breast fed every three hours, but took rather little milk. The stools were somewhat more green than normal, but the child seemed to be perfectly well and, when the nurse left at the 12th day, had regained exactly her birth weight. On the 15th day a black patch was noticed on the flexor aspect of the right wrist, and that night and the next the child slept poorly and was disinclined for food, but seemed otherwise well. On the 17th evening a black mark was seen on the dorsum of the left ankle, and next day two other blue patche3 were noticed, one extensive on the right hip. The child was brought to hospital and admitted in the early evening. On admission her temperature was 968', pulse 160, and respirations 44 per minute. The child looked wasted, the skin was loose and inelastic, the weight only 5 lb. 7 oz., so that a rapid loss had taken place in a few days. On the right hip, just over the trochanter, was a large round purple-black patch (5 bv 4-5 cm.) with a dark red margin, neither raised nor very indurated. There were smaller similar oblong patches on the right wrist and left ankle. Nothing abnormal was found on general examination elsewhere, although the child was evidently extremely ill. The child was fed every 24 hours on Nestle's milk (1 part in 10 water) with lactose added, so that the diet contained 18-20 grm. carbohydrate per day. Brandy, 2 minims, was added to alternate feeds.