A case report of hyperosmolar hyperglycemic state in a 7-year-old child

Abstract

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.

Hyperosmolar hyperglycaemic state (HHS) as the first manifestationof type 2 diabetes in a child

“…Undiagnosed diabetes mellitus, most often type 2, with underlying infection is the most common cause of HHS, as it was in the presented case [1]. It is, however, still an unusual presentation of type 2 diabetes in children, found in 2% of cases, developing due to diagnosis delay, which also occurred in our patient [3][4][5]. Recent studies showed an increase of HHS prevalence in the paediatric population [6,7]; it is therefore important to know how to diagnose and treat this condition.…”

“…It is believed to be associated with a delay in the diagnosis of these diseases. Mortality in the course of HHS reaches 20-30%, and it is approximately 10-times higher than in diabetic ketoacidosis (DKA) [3,4].…”

Hyperglycaemic hyperosmolar state: first presentation of type 1 diabetes mellitus in an adolescent with complex medical needs

“…Cho et al reported HHS as the first presentation of type 1 DM in a 7-year-old girl 11. Although she appeared cachectic, her mental status was normal.…”

Hyperglycaemic hyperosmolar state and cerebral thrombophlebitis in paediatrics: A case report

“…The mortality rate in patient with HHS varies between 20% and 60% and timely diagnosis as appropriate treatment prevent complications and death. 2,3,17 The child presented with hyperglycaemia without acidosis, which could have led to a delayed diagnosis of diabetes 1. Contrary to diabetic ketoacidosis, HHS is characterized by development of a severe hyperglycaemia without acidosis, these patients maintain a low insulin production leading to the absence or underproduction of ketones via lipolysis.…”