Hyperosmolar hyperglycemic state without ketosis in a toddler with type 1 diabetes

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Ibrahim M Alharfi1, Ram Singh, Cheril Clarson

  • 1From the *Department of Pediatrics, Western University, London, Ontario, Canada; and †Department of Pediatric Critical Care, King Fahad Medical City, Riyadh, Saudi Arabia.

Pediatric Emergency Care
|July 3, 2014
PubMed

Insights

A thin toddler presented with hyperglycemic hyperosmolar syndrome, not diabetic ketoacidosis, after consuming sugary drinks, indicating a potential rise in type 1 diabetes mellitus cases. This presentation requires specific emergency care awareness in young children.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Clinical Medicine

Background:

  • Type 1 diabetes mellitus (T1DM) typically presents with diabetic ketoacidosis (DKA) in children.
  • Hyperglycemic hyperosmolar syndrome (HHS) is less common in pediatric T1DM.
  • Dietary factors, such as high-sugar beverage intake, are increasingly scrutinized in T1DM development.

Observation:

  • A case study of a thin toddler with T1DM is presented.
  • The initial presentation was HHS without DKA.
  • This followed the ingestion of large quantities of high-sugar beverages.

Findings:

  • The patient's presentation of T1DM as HHS without DKA is unusual for the pediatric population.
  • Increased consumption of sugar-sweetened beverages may be linked to this specific T1DM presentation.
  • This clinical scenario highlights a potential shift in T1DM manifestation in very young children.

Implications:

  • Emergency care physicians need to recognize HHS without DKA as a possible T1DM presentation in toddlers.
  • Management strategies for HHS in T1DM differ from those for DKA.
  • Early recognition and appropriate management are crucial for favorable outcomes in pediatric T1DM.

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