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[Pediatric hyperglycemic hyperosmolar coma diabeticum: diagnostic evaluation and therapeutic concept]
J Wetter1, B C Gohlke, S Stutte
1Pädiatrische Endokrinologie und Diabetologie, Universitätskinderklinik Bonn, Germany. joachim.woelfl e@ukb.uni-bonn.de
Klinische Padiatrie
|November 11, 2011
Summary
Hyperglycemic hyperosmolar coma (HHC) in children is rare but serious, causing significant mortality. Treatment focuses on careful fluid administration, gradual glucose reduction, and intensive monitoring, with low-dose insulin potentially beneficial.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Metabolic Disorders
Background:
- Hyperglycemic hyperosmolar coma (HHC) is a rare but life-threatening diabetic emergency in children.
- It presents with hyperglycemia, hyperosmolality, and minimal acidosis, leading to severe complications like cerebral edema and rhabdomyolysis.
- Evidence-based guidelines for managing pediatric HHC are scarce.
Purpose of the Study:
- To review current literature on pediatric Hyperglycemic Hyperosmolar Coma (HHC).
- To discuss available treatment options for pediatric HHC.
- To propose a therapeutic concept for managing this condition in children.
Main Methods:
- A comprehensive literature review was conducted.
- Treatment strategies for pediatric HHC were analyzed.
- A therapeutic concept was developed based on the findings.
Main Results:
- Pediatric HHC requires intensive care unit (ICU) admission and close monitoring.
- Key treatment components include adequate fluid resuscitation and cautious serum glucose level reduction.
- Low-dose and delayed insulin administration appears to be a favorable approach.
Conclusions:
- Effective management of pediatric Hyperglycemic Hyperosmolar Coma (HHC) necessitates prompt and careful intervention.
- Fluid administration and controlled glucose lowering are crucial.
- A structured therapeutic approach, including judicious insulin use, can mitigate morbidity and mortality.
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