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[Hyperosmolar non-ketotic diabetic coma in children (author's transl)]
Anales Espanoles De Pediatria
|September 1, 1980
Summary
A 12-year-old presented with hyperosmolar hyperglycemic coma, a rare initial sign of diabetes mellitus. Treatment involved insulin, fluids, and early potassium, leading to recovery and resolution of a subsequent iliofemoral thrombophlebitis.
Area of Science:
- Endocrinology
- Pediatric Endocrinology
- Metabolic Disorders
Background:
- Hyperosmolar hyperglycemic coma (HHC) is a severe diabetic complication typically seen in adults.
- Non-ketotic HHC as the initial presentation of diabetes mellitus (DM) is exceptionally rare in pediatric patients.
- This case highlights a unique initial manifestation of DM in a young adolescent.
Observation:
- A 12-year-old female presented with non-ketotic hyperosmolar hyperglycemic coma.
- The patient's C-peptide levels were near normal during the coma, suggesting endogenous insulin production.
- During recovery, she developed left iliofemoral thrombophlebitis, which subsequently resolved.
Findings:
- Successful management of non-ketotic HHC was achieved with continuous low-dose insulin infusion and isotonic saline/glycosaline solutions.
- Early administration of potassium was crucial in the hydrating solutions.
- The thrombophlebitis complication was effectively treated, indicating the importance of vigilant monitoring during convalescence.
Implications:
- This case underscores that HHC can be the presenting sign of DM in children, even without ketoacidosis.
- It emphasizes the importance of considering DM in pediatric patients with HHC and assessing pancreatic insulin reserve via C-peptide.
- The successful management protocol offers insights into treating similar rare pediatric presentations and managing associated complications like thrombophlebitis.