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4 year old having frequent urination with pain, weight loss, fatigue and wetting pants. Why is this happening ?

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Internal Medicine Specialist
Practicing since : 2001
Answered : 2272 Questions
I have a quick question about pediatric urology. My four year old nephew has recently experienced frequent urination (up to 30x/day), a 4lb weight loss in a month, some mild fatigue and has started wetting his pants which he has not done in more than a year. He also appears to have a slightly "puffed out" abdomen even though he is very thin otherwise. His urinary meatus is also very sore and he complains of some pain with urination, which I'm sure is the result of the polyuria. I am a nurse so I suggested that he be tested for type I DM, but his fasting glucose came back normal at 88 mg/dL. Other labs were drawn, however, the only abnormal result was an elevated ESR at 65. Apparently, his kidney function was not evaluated - which I think should have been. He is scheduled to undergo a renal scan and abdominal ultrasound this week. However, is there something else that we should be looking into? Thanks!

Sincerely, XXXXXXX
Posted Fri, 13 Jul 2012 in Child Health
Answered by Dr. Ram Choudhary 4 hours later

Thanks for the query.

The child's symptoms of urination almost 30 /day is definitely abnormal, even if reports are OK the patient has got something wrong which must be detected. In the first place I would say it must be a Diabetes insipidus,
*Renal tubular acidosis,
*Genitourinary tuberculosis or
*Just a behaviour disorder of excessive urination - an OCD.

Your Psychiatrician will advise antidepressant in low doses that is also helpful if this is the case.

Simultaneously investigate him. If I were to be his treating doctor, I would order the following test:
1. Complete Blood count,
2. Ultrasound whole abdomen,
3. Urine routine and culture/sensitivity,
4. Urine osmolality, Urine pH, Urine sodium,
5. Urinary ketones / sugar

This work should lead you to the cause.

I hope that answered your query. Should you have any further concerns, feel free to ask me. I will be glad to address it.

Best regards
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