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Hyperglycaemic hyperosmolar state and cerebral thrombophlebitis in paediatrics: A case report
Maud Injeyan1, Sabine Baron1,2, Benjamin Lauzier3,4
1Department of Pediatrics, CHU de Nantes, Nantes, France.
Insights
Hyperglycaemic hyperosmolar state (HHS) can occur in type 1 diabetes, especially after consuming sugary drinks. This case shows HHS can lead to cerebral venous thrombosis in children, emphasizing gradual osmolarity reduction during treatment.
Area of Science:
- Pediatrics
- Endocrinology
- Neurology
Background:
- Hyperglycaemic hyperosmolar state (HHS) is a serious complication of diabetes mellitus.
- While known in type 2 diabetes, HHS can also present severely in type 1 diabetes, particularly with high-sugar fluid intake.
- HHS management is complex and associated with severe complications, including cerebral venous thrombosis.
Introduction:
Hyperglycaemic hyperosmolar state (HHS) is a known complication of type 2 diabetes mellitus; however, carbonated carbohydrate fluid intake may precipitate a more severe presentation of type 1 diabetes mellitus with hyperosmolar state. The management of these patients is not easy and can lead to severe complications such as cerebral venous thrombosis.
Methods:
We present the case of a 21-month-old boy admitted for consciousness disorders revealing a hyperglycaemic hyperosmolar state on a new-onset type 1 diabetes and who developed cerebral venous thrombosis.
Results And Conclusion:
Emergency physicians should be aware of HHS in order to start the appropriate treatment as early as possible and to monitor the potential associated acute complications. This case highlights the importance of decreasing very gradually the osmolarity in order to avoid cerebral complications. Cerebral venous thrombosis in HHS paediatric patients is rarely described, and it is important to recognize that not all episodes of acute neurological deterioration in HHS or diabetic ketoacidosis are caused by cerebral oedema.
