Next Step?

I have a 16 yr. old daughter who has been ill for three weeks now.  It started with neck pain (I thought she slept wrong), then chest pain, dizziness & general malaise - but no fever.  We took her to an after-hours doctor who said that it was some kind of a virus and gave her Naproxyn for pain.  The second week into it she became worse with the dizziness and feeling tired and while on a vacation (which she stayed in the bed in the hotel) she felt so bad that we took her in the ER.  Tests were normal, except for a blood sugar of 135 and low potassium.  She had not eaten all day, so the blood sugar was fasting.  However, she had enough liquids so as not to be dehydrated - which they thought she was with the low potassium & gave her a liter of fluid.  The doc commented that she felt hot on her neck and back and asked that her temp be taken again - which was normal.  We left town early due to her condition & she had nausea & vomiting for the next 24 hours.  So, we took her in to her regular doctor after getting home and he thought she had vertigo.  The vomiting ceased, but the other symptoms remained - neck pain, dizziness & tiredness.  He suggested taking her to an ENT, but we wanted another opinion from a gen. practitioner.  He commented that her neck felt hot, but no fever.  Blood tests in his office showed initially a blood glucose of 122 and she had not eaten for at least four hours.  The rest of the tests were sent out and I got the results today that shows Neutrophils - 73, Lymphs - 21, serum potassium 5.7 & alkaline phosphatase 43.  These were the only ones marked as being abnormal according to their reference range for her age.  The glucose was 94.  As of today she still complains of neck pain (which is hot to touch), but there is no obvious swelling or redness.  She still complains of lethargy and not being able to sleep due to feeling so bad.  She eats only crackers and yogurt as she says most other foods make her nauseated or she doesn't feel like it.  She's lost 10 pounds and now weighs 100 on a 5'2' frame.  The blood glucose is significant to me because on my maternal side of the family five members have/had Type II diabetes and I had gestational diabetes when pregnant with her.  I don't think the higher than normal blood sugar is causing her problems, but I'm not a doctor either.  I'm just concerned that she's showing strong indicators of developing this disease.  

So, where do I go from here?  Do I take her to an internist, neurologist or who?  I'm at a lost as to where to proceed from here.  

Thanks for your time,
kdmom

[Kevin Pho, MD]

Diabetes should certainly be considered.  A fasting blood sugar above 126 would be diagnostic of diabetes - you may want to repeat these test to confirm the diagnosis.  An internist would be the one would would be able to help this.

Regarding the neck pain, if it is hot to the touch, you want to exclude infection.  A neck CT scan can be considered to evaluate for any abscesses that may be present and can cause warmth and lethargy.  

Regarding the high potassium - this is interesting at such a young age.  A quick blood test to evaluate the kidney function can be considered for further evaluation, since any kidney dysfunction (i.e. from dehydration) can cause this.  

Again, I would suggest a referral to an internal medicine physician for further evaluation and then do more specialized referrals after that visit.  

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

**Note: I'll be away until August 14th - The forums will re-open then.**

[kevinmd]

**Note: I'll be away until August 14th - The forums will re-open then.**