{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:26:53Z","timestamp":1786739213092,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:p>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\u2019s 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\u2014especially in rural healthcare settings.<\/jats:p>","DOI":"10.4103\/jfmpc.jfmpc_1311_25","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T14:01:20Z","timestamp":1779544880000},"page":"1850-1854","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Grief, bias, and vigilance: A holistic rural case of pediatric diabetic ketoacidosis unmasked through diagnostic insight\u2014A case report"],"prefix":"10.4103","volume":"15","author":[{"given":"Miloni Mineshbhai","family":"Nada","sequence":"first","affiliation":[{"name":"Rural Medical Officer, Dhanori Primary Health Center, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj R.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Gram Seva Trust Sarvajanik Hospital, Kharel, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hairya Ajaykumar","family":"Lakhani","sequence":"additional","affiliation":[{"name":"Smt. B.K. Shah Medical Institute and Research Centre, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"key":"R2-20260603","doi-asserted-by":"crossref","first-page":"110","DOI":"10.3390\/children12010110","article-title":"Severe diabetic ketoacidosis in children with type 1 diabetes: Ongoing challenges in care","volume":"12","author":"Foti","year":"2025","journal-title":"Children"},{"key":"R3-20260603","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s40138-025-00311-3","article-title":"Diabetic Ketoacidosis in pediatric emergency medicine: Risk factors, myths, and evidence-based management of complications","volume":"13","author":"Alsabri","year":"2025","journal-title":"Curr Emerg Hosp Med Rep"},{"key":"R4-20260603","doi-asserted-by":"crossref","first-page":"2802","DOI":"10.1097\/MS9.0000000000000894","article-title":"Comprehensive review of diabetic ketoacidosis: An update","volume":"85","author":"Elendu","year":"2023","journal-title":"Ann Med Surg"},{"key":"R5-20260603","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s40653-021-00435-0","article-title":"Developmental manifestations of grief in children and adolescents: Caregivers as key grief facilitators","volume":"16","author":"Alvis","year":"2022","journal-title":"J Child Adolesc Trauma"},{"key":"R6-20260603","doi-asserted-by":"crossref","first-page":"40","DOI":"10.7861\/fhj.2020-0233","article-title":"Implicit bias in healthcare: Clinical practice, research and decision making","volume":"8","author":"Gopal","year":"2021","journal-title":"Future Healthc J"},{"key":"R7-20260603","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1186\/s12913-022-08527-9","article-title":"Impact of low health literacy on patients'health outcomes: A multicenter cohort study","volume":"22","author":"Shahid","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"R8-20260603","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.bjae.2021.07.004","article-title":"Cognitive biases in diagnosis and decision making during anaesthesia and intensive care","volume":"21","author":"Webster","year":"2021","journal-title":"BJA Educ"},{"key":"R10-20260603","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4103\/0973-1075.197960","article-title":"A concept analysis of holistic care by hybrid model","volume":"23","author":"Jasemi","year":"2017","journal-title":"Indian J Palliat Care"},{"key":"R11-20260603","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1177\/19322968221081133","article-title":"Role of telemedicine in diabetes management","volume":"17","author":"Dhediya","year":"2022","journal-title":"J Diabetes Sci Technol"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1311_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:26:48Z","timestamp":1786735608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1311_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":9,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1311_25","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-07-18","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-18","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}