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Hyperosmolar hyperglycemic state in children: case report and review of the literature

Iraj Shahramian1, Pouya Ostad Rahimi1, Sepideh Radvar2

  • 1Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran.

Journal Fur Klinische Endokrinologie Und Stoffwechsel
|June 7, 2022
PubMed

Insights

Hyperosmolar hyperglycemic state (HHS) is a rare but serious emergency in children, often linked to type 1 diabetes. Prompt treatment with fluids and insulin can lead to recovery, highlighting the need for physician awareness.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders

Background:

  • Hyperosmolar hyperglycemic state (HHS) is a rare, life-threatening emergency in children.
  • It is characterized by severe hyperglycemia and hyperosmolarity, with minimal ketosis.
  • The prevalence of HHS in pediatric populations is increasing.

Purpose of the Study:

  • To report a case of severe HHS in a 9-year-old boy with type 1 diabetes.
  • To highlight the clinical manifestations and management of HHS in children.
  • To emphasize the importance of differentiating HHS from diabetic ketoacidosis (DKA).

Main Methods:

  • Case report of a 9-year-old male with type 1 diabetes presenting with severe HHS.
  • Initial assessment included serum glucose, osmolarity, and evaluation for complications.
  • Management involved invasive fluid resuscitation and insulin administration.

Main Results:

  • The patient presented with a serum glucose level of 1600 mg/dL and multiple HHS complications.
  • Complications included decreased consciousness, hypovolemic shock, and acute kidney injury.
  • The patient showed a positive response to treatment and was discharged in stable condition.

Conclusions:

  • HHS is an increasing concern in pediatric type 1 diabetes.
  • Early recognition and prompt management are crucial for favorable outcomes.
  • Physicians must be vigilant for unusual HHS presentations in children and distinguish it from DKA.

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