A 15-year-old girl with a history of poorly controlled type 1 diabetes mellitus presents to the emergency department with a 4-day history of generalized swelling. She initially noticed bilateral lower extremity edema and right-sided facial swelling that subsequently progressed to include both sides of her face, her abdomen, pelvis, and labia. She also reports a 9-lb (3.54-kg) weight gain. She denies pain, fever, vomiting, loose stools, chest pain, or shortness of breath. Current medications include insulin glargine and insulin aspart. She has only become compliant with this therapy in the past week.

On physical examination, the teen’s weight is 51 kg (41st percentile), height is 155 cm (13th percentile), and body mass index is 20.1 (54th percentile). Her vital signs are within normal limits. She is in no acute distress. She has mild facial edema, moderate abdominal distention without fluid wave, mild right upper quadrant tenderness, and 2+ pitting edema...

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