Patient Summary:

• Age: 6 years (Paediatric case)
• Weight: Not specified
• Presentation: One-week history of progressive periorbital and lower limb oedema, heavy proteinuria, hypoalbuminaemia, hyperlipidaemia
• Renal Function: Normal
• Blood Pressure: Normal
• Diabetes Type: Not applicable (No evidence of diabetes)

Diagnosis:

Nephrotic Syndrome (likely Minimal Change Disease – most common cause in children)

Severity Level:

Moderate to Severe (due to marked oedema and heavy proteinuria; child at risk for complications but haemodynamically stable)

Immediate Management (First Hour):

This is NOT a diabetes emergency. Instead, this is a classic presentation of Idiopathic Nephrotic Syndrome (INS) in childhood, usually Minimal Change Disease.

1. Hospital Admission

• Admit for monitoring, initial management, and education.

2. Initial Investigations

• Bloods: Full blood count, urea and electrolytes, albumin, creatinine, lipid profile, liver function, coagulogram
• Urine: Protein:creatinine ratio, urinalysis (no evidence of nephritic syndrome — no haematuria or hypertension), urine culture (rule out infection)
• Exclude secondary causes: Screen for SLE, Hepatitis B/C, HIV if risk factors.

3. Fluid Management

• Restrict fluids to reduce oedema (usually maintenance requirement, sometimes 80% of normal).
• Salt restriction (<2 g/day).
• Monitor for hypovolaemia: (tachycardia, hypotension).

4. Diuretics

• Furosemide may be used if distressing oedema and normal volume status:
  • Dose: 1–2 mg/kg orally once/twice daily
  • Caution: Risk of intravascular depletion.

5. Corticosteroid Therapy (Mainstay)

• Prednisolone: 60 mg/m²/day (max 60 mg) single morning dose for 4 weeks, then 40 mg/m² (max 40 mg) alternate days for 4 weeks, then taper.
• Confirm vaccination status for varicella, pneumococcus.

6. Infection prevention

• Prophylactic antibiotics generally not needed, but high index of suspicion for infection (sepsis, peritonitis).
• Vaccinate against pneumococcus/influenza if not already.

7. Monitoring

• Daily weight
• Daily measurement of urine protein (dipstick)
• Monitor blood pressure
• Monitor for signs of infection

Monitoring Schedule:

• Hourly: If IV diuretics or unstable, otherwise not required
• Daily: Weight, urine dipstick for protein, fluid balance, examination for infection
• 48–72h: Bloods (albumin, electrolytes, renal function, lipid profile)

Safety Alerts & Escalation:

• Call Senior/ICU if:
  • Sudden abdominal pain (suspect peritonitis)
  • Hypotension/tachycardia (hypovolaemia)
  • Oliguria/anuria
  • Respiratory distress (pulmonary oedema)
• Adjust if:
  • Rapid weight loss with diuretics
  • Electrolyte disturbance
• Consults needed:
  • Paediatric Nephrologist
  • Dietician
  • Medical Social Worker

Discharge Readiness Checklist:

• Oedema improved or resolving
• Patient tolerating oral intake
• Proteinuria resolving
• Home urine protein monitoring taught to family
• Educated on infection risks, when to seek help
• Arranged follow-up for steroid taper and complications monitoring

24-Hour Plan:

Summary: This is a classic case of paediatric nephrotic syndrome (likely idiopathic/minimal change), presenting with periorbital and peripheral oedema, heavy proteinuria, mid hypoalbuminaemia, and no renal dysfunction, hypertension, or haematuria. Immediate management is hospital admission, fluid/Na restriction, daily steroids, vigilant monitoring for infection and hypovolaemia, and family education. Consult paediatric nephrology for ongoing care.

This is not a diabetes emergency. If you suspect underlying diabetes in future presentations (polyuria/polydipsia, DKA), use diabetes emergency guidelines.