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A child with altered sensorium, hyperglycemia, and elevated troponins

Rajan Arora1, Saurabh Chiwane1, Earl Hartwig1

  • 1Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.

The Journal of Emergency Medicine
|July 25, 2013
PubMed

Insights

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) can present with overlapping symptoms in children, complicating diagnosis. Prompt recognition of these diabetic emergencies is crucial for effective treatment and improved patient outcomes.

Area of Science:

  • Pediatric Endocrinology
  • Emergency Medicine
  • Metabolic Disorders

Background:

  • Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are severe diabetes mellitus complications.
  • DKA and HHS are distinct entities requiring tailored management strategies.
  • Distinguishing between DKA and HHS can be challenging, particularly in pediatric patients.

Observation:

  • A 12-year-old presented with a mixed picture of DKA and HHS coma.
  • The patient experienced myocardial strain and acute renal insufficiency.
  • Metabolic derangements were identified as the cause of the patient's complications.

Findings:

  • The case highlights the diagnostic difficulty in differentiating DKA and HHS in children.
  • Overlapping clinical features can obscure the precise diagnosis.
  • Myocardial strain and acute renal insufficiency were noted complications.

Implications:

  • Emergency physicians must be aware of diverse hyperglycemic emergency presentations in children.
  • Accurate diagnosis is essential for initiating appropriate and timely treatment.
  • Recognizing varied presentations improves management and patient outcomes in pediatric diabetes emergencies.
Abstract

Keywords:
altered sensoriumchildrenhyperglycemiatroponin

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