Hiperglycemic hyperosmolar state: An unsual way of first appearance of type 1 diabetes in children

Hyperosmolar hyperglycemic state in children: case report and review of the literature

Hyperosmolar hyperglycemic state (HHS) is a rare complication in children and a life-threatening emergency that presents with a significant increase in blood sugar and hyperosmolarity with or without low ketosis. This study reports the case of a 9-year-old boy with severe HHS due to type 1 diabetes. The patient’s initial serum glucose level was 1600; however, he was discharged in a stable condition. The patient presented many of the known complications of HHS, including decreased level of consciousness, hypovolemic shock, acute kidney injury, and very high serum glucose levels. The patient responded well to invasive fluid resuscitation and insulin administration, was discharged in good general condition without HHS-related complications, and was followed up with insulin therapy. As the prevalence of HHS in children is increasing, it is necessary for physicians to be aware of the unusual manifestations in children, especially children with type 1 diabetes, and to have the ability to diagnose and manage HHS and differentiate it from diabetic ketoacidosis.

A case report of hyperosmolar hyperglycemic state in a 7-year-old child: An unusual presentation of first appearance of type 1 diabetes mellitus

RATIONALE

A hyperosmolar hyperglycemic state (HHS) is a rare presentation of a hyperglycemic crisis in children with diabetes mellitus. As this condition can be fatal and has high morbidity, early recognition and proper management are necessary for a better outcome. Here, we report a rare case of HHS as the first presentation of type 1 diabetes mellitus (T1DM) in a 7-year-old girl.

PATIENT CONCERNS

The patient was admitted due to polyuria and weight loss in the past few days. The initial blood glucose level was 1167mg/dL.

DIAGNOSES

On the basis of clinical manifestations and laboratory results, she was diagnosed with T1DM and HHS.

INTERVENTIONS

Treatment was started with intravenous fluid and regular insulin.

OUTCOMES

She was discharged without any complications related to HHS and is being followed up in the outpatient clinic with split insulin therapy.

LESSONS

As the incidence of T1DM is increasing, emergency physicians and pediatricians should be aware of HHS to make an early diagnosis for appropriate management, as it can be complicated in young children with T1DM.