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Childhood diabetes presenting with hyperosmolar dehydration but without ketoacidosis: a report of three cases

M J R Kershaw1, T Newton, T G Barrett

  • 1Birmingham Children's Hospital, Endocrinology and Diabetes, Birmingham, UK. melanie@packwood-cottages.freeserve.co.uk

Diabetic Medicine : a Journal of the British Diabetic Association
|April 22, 2005
PubMed

Insights

Diabetic ketoacidosis (DKA) is common in children. A rare, serious complication, hyperosmolar hyperglycemia without DKA, presents unique risks, particularly cerebral edema.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders

Background:

  • Diabetic ketoacidosis (DKA) is a frequent initial presentation of diabetes mellitus in children.
  • Hyperglycaemia and hyperosmolality without ketoacidosis are rare but serious metabolic complications.

Observation:

  • Three pediatric cases initially suspected as DKA presented with severe hyperglycemia and hyperosmolarity but minimal ketosis or acidosis.
  • Two cases involved high-calorie fluid intake preceding the hyperosmolar state.
  • These children demonstrated significant insulin sensitivity.

Findings:

  • Hyperosmolar hyperglycemia without DKA is a distinct and serious presentation in pediatric diabetes.
  • Children with this condition may have a higher risk of cerebral edema compared to DKA.

Implications:

  • Distinguishing hyperosmolar hyperglycemia from DKA is crucial for appropriate management in children.
  • A low threshold for suspecting cerebral edema is necessary in these patients.
Abstract

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