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Combined Hyperglycemic Hyperosmolar Syndrome and Diabetic Ketoacidosis Associated with COVID-19 in a Pediatric

Yu Shan Tseng1, Bradley Tilford2, Usha Sethuraman3

  • 1Department of Pediatrics, Division of Pediatric Critical Care, Children's Hospital of Michigan, Detroit, Michigan, USA.

Case Reports in Critical Care
|March 5, 2024
PubMed

Insights

This study reports a severe case of mixed hyperosmolar hyperglycemic syndrome (HHS) with diabetic ketoacidosis (DKA) in an adolescent with COVID-19. Early treatment with Remdesivir and corticosteroids is recommended for this rare pediatric complication.

Area of Science:

  • Pediatric Endocrinology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • While many children with COVID-19 exhibit mild symptoms, a subset requires intensive care.
  • Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are known COVID-19 complications in adults.
  • Pediatric cases of COVID-19-associated DKA and HHS are infrequently reported.

Observation:

  • A case of a severe mixed HHS with DKA in an adolescent with COVID-19 is presented.
  • The adolescent patient presented with significant hyperglycemia and metabolic derangement.

Findings:

  • The patient was successfully treated with a combination of intravenous immunoglobulin, Remdesivir, and methylprednisolone.
  • This case highlights a rare but severe metabolic complication of COVID-19 in a pediatric patient.

Implications:

  • Clinicians should maintain a high index of suspicion for HHS with DKA in pediatric COVID-19 patients.
  • Early consideration of antiviral therapy (Remdesivir) and corticosteroids may be beneficial in managing this syndrome.
  • Further research is needed to elucidate the pathophysiology linking COVID-19 to these severe hyperglycemic states in children.

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