Diazoxide-Associated Hyperglycemia: A Critical Case Precipitating Hyperosmolar Hyperglycemic State in a Child

Area of Science:

• Pediatric Endocrinology
• Clinical Pharmacology
• Medical Case Reports

Background:

• Diazoxide is a first-line treatment for hyperinsulinemic hypoglycemia (HI) in children, effectively managing blood glucose by suppressing insulin release.
• Hyperosmolar hyperglycemic state (HHS) is a rare but serious side effect of diazoxide therapy, with limited pediatric case documentation.
• Understanding diazoxide's side effect profile is crucial for managing pediatric endocrine disorders and preventing severe complications.

Observation:

• An 8-year-old female with genetic hyperinsulinemia presented with hypovolemic shock, severe dehydration, and encephalopathy.
• Laboratory findings revealed severe hyperglycemia (glucose > 600 mg/dL, rising to 2105 mg/dL), consistent with HHS and acute kidney injury.
• Elevated serum diazoxide concentration was detected, correlating with the patient's hyperglycemic state.

Findings:

• The patient's presentation of HHS was attributed to elevated serum diazoxide levels, potentially exacerbated by dehydration-induced renal impairment.
• Reduced renal clearance of diazoxide due to dehydration likely led to increased drug concentration and subsequent worsening hyperglycemia.
• Differential diagnoses were considered but did not fully explain the clinical presentation, strengthening the hypothesis of diazoxide-induced HHS.

Implications:

• This case underscores the critical, potentially lethal complication of HHS as a side effect of diazoxide therapy in children.
• It emphasizes the importance of monitoring serum diazoxide levels, especially in patients with compromised renal function or dehydration.
• Clinical vigilance is required to differentiate diazoxide-induced HHS from other hyperglycemic emergencies in pediatric patients.