Grief, bias, and vigilance: A holistic rural case of pediatric diabetic ketoacidosis unmasked through diagnostic insight-A case report.

Abstract

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus. In emotionally charged situations such as bereavement, symptoms may be misattributed to psychological distress, risking delayed diagnosis. We report a 12-year-old girl who presented to a rural primary health center (PHC) with lethargy, shortness of breath, and persistent crying following her grandmother's sudden death. The overlap of grief-related psychological distress and evolving metabolic symptoms created a diagnostic challenge, initially masking an underlying endocrine emergency. However, through clinical vigilance, careful observation, and point-of-care glucose testing, we uncovered hyperglycemia, raising suspicion of DKA. Early stabilization and prompt referral led to a positive outcome at the tertiary care center. This case highlights the importance of maintaining diagnostic vigilance and avoiding cognitive biases such as anchoring, particularly in emotionally charged scenarios. It underscores how clinical humility, patience, and a holistic approach that integrates physical, emotional, and social well-being can transform potential tragedies into positive outcomes-especially in rural healthcare settings.