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Hyperglycemic hyperosmolar non-ketotic syndrome in children with type 2 diabetes*

Shannon H Fourtner1, Stuart A Weinzimer, Lorraine E Levitt Katz

  • 1Department of Pediatrics, Division of Endocrinology/Diabetes, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. fourtner@email.chop.edu

Pediatric Diabetes
|August 20, 2005
PubMed

Insights

Hyperglycemic hyperosmolar non-ketotic (HHNK) syndrome, though rare in children, occurred in 3.7% of new type 2 diabetes cases. While most survivors had no lasting effects, the syndrome presented a significant mortality risk.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Mellitus

Background:

  • Hyperglycemic hyperosmolar non-ketotic (HHNK) syndrome is considered rare in children.
  • Increasing prevalence of childhood obesity and type 2 diabetes may lead to more HHNK syndrome cases.
  • Existing literature primarily consists of case reports, lacking updated information on typical clinical course and outcomes.

Purpose of the Study:

  • To provide updated information on the clinical course and sequelae of HHNK syndrome in pediatric patients.
  • To assess the frequency of HHNK syndrome in children diagnosed with type 2 diabetes.
  • To highlight the association between HHNK syndrome and new-onset type 2 diabetes in children.

Main Methods:

  • Retrospective chart review of patients diagnosed with type 2 diabetes at Children's Hospital of Philadelphia over 5 years.
  • Screening for laboratory evidence of HHNK syndrome using standard diagnostic criteria (blood glucose >600 mg/dL, serum osmolality >330 mOsm/L, mild acidosis).
  • Analysis of clinical presentation, demographic data, and patient outcomes.

Main Results:

  • Seven out of 190 patients (3.7%) with type 2 diabetes met the criteria for HHNK syndrome.
  • All seven patients were African-American, with a mean age of 13.3 years, and HHNK syndrome was their initial presentation of diabetes.
  • The case fatality rate was 14.3% (one death), with survivors experiencing an average hospital stay of 10 days and no neurodevelopmental sequelae.

Conclusions:

  • HHNK syndrome occurs in a notable percentage of pediatric type 2 diabetes cases.
  • Increased awareness of type 2 diabetes in children is crucial for preventing HHNK syndrome.
  • Early recognition and management can mitigate the significant morbidity and mortality associated with HHNK syndrome in pediatric patients.
Abstract

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