PMID- 30836328
OWN - NLM
STAT- Publisher
LR  - 20240227
IS  - 2052-0573 (Print)
IS  - 2052-0573 (Electronic)
IS  - 2052-0573 (Linking)
VI  - 2019
DP  - 2019 Mar 5
TI  - Hyperglycemic hyperosmolar state in an adolescent with type 1 diabetes mellitus.
LID - EDM180131 [pii]
LID - 10.1530/EDM-18-0131 [doi]
LID - 18-0131
AB  - Hyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) are the 
      most severe acute complications of diabetes mellitus (DM). HHS is characterized 
      by severe hyperglycemia and hyperosmolality without significant ketosis and 
      acidosis. A 14-year-old Japanese boy presented at the emergency room with 
      lethargy, polyuria and polydipsia. He belonged to a baseball club team and 
      habitually drank sugar-rich beverages daily. Three weeks earlier, he suffered 
      from lassitude and developed polyuria and polydipsia 1 week later. He had been 
      drinking more sugar-rich isotonic sports drinks (approximately 1000-1500 mL/day) 
      than usual (approximately 500 mL/day). He presented with HHS (hyperglycemia (1010 
      mg/dL, HbA1c 12.3%) and mild hyperosmolality (313 mOsm/kg)) without acidosis (pH 
      7.360), severe ketosis (589 mumol/L) and ketonuria. He presented HHS in type 1 
      diabetes mellitus (T1DM) with elevated glutamate decarboxylase antibody and islet 
      antigen 2 antibody. Consuming beverages with high sugar concentrations caused 
      hyperglycemia and further exacerbates thirst, resulting in further beverage 
      consumption. Although he recovered from HHS following intensive transfusion and 
      insulin treatment, he was significantly sensitive to insulin therapy. Even the 
      appropriate amount of insulin may result in dramatically decreasing blood sugar 
      levels in patients with T1DM. We should therefore suspect T1DM in patients with 
      HHS but not those with obesity. Moreover, age, clinical history and body type are 
      helpful for identifying T1DM and HHS. Specifically, drinking an excess of 
      beverages rich in sugars represents a risk of HHS in juvenile/adolescent T1DM 
      patients. Learning points: Hyperglycemic hyperosmolar state (HHS) is 
      characterized by severe hyperglycemia and hyperosmolality without significant 
      ketosis and acidosis. The discrimination between HHS of type 1 diabetes mellitus 
      (T1DM) and type 2 diabetes mellitus (T2DM) in initial presentation is difficult. 
      Pediatrician should suspect T1DM in patients with HHS but not obesity. Age, 
      clinical history and body type are helpful for identifying T1DM and HHS. Children 
      with T1DM are very sensitive to insulin treatment, and even appropriate amount of 
      insulin may result in dramatically decreasing blood sugar levels.
FAU - Watanabe, Suguru
AU  - Watanabe S
AD  - Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, 
      Kumamoto, Japan.
AD  - Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto 
      University, Kumamoto, Japan.
FAU - Kido, Jun
AU  - Kido J
AD  - Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto 
      University, Kumamoto, Japan.
FAU - Ogata, Mika
AU  - Ogata M
AD  - Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, 
      Kumamoto, Japan.
FAU - Nakamura, Kimitoshi
AU  - Nakamura K
AD  - Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto 
      University, Kumamoto, Japan.
FAU - Mizukami, Tomoyuki
AU  - Mizukami T
AD  - Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, 
      Kumamoto, Japan.
LA  - eng
PT  - Journal Article
DEP - 20190305
PL  - England
TA  - Endocrinol Diabetes Metab Case Rep
JT  - Endocrinology, diabetes & metabolism case reports
JID - 101618943
PMC - PMC6432974
OTO - NOTNLM
OT  - 2019
OT  - Adolescent/young adult
OT  - Anti-islet cell antibody
OT  - Asian - Japanese
OT  - BMI
OT  - Beta-hydroxybutyrate
OT  - C-peptide (blood)
OT  - Dehydration
OT  - Diabetes
OT  - Diabetes mellitus type 1
OT  - Diet
OT  - Emergency
OT  - Fatigue
OT  - GADA
OT  - General practice
OT  - Glucose (blood)
OT  - Haemoglobin A1c
OT  - Hyperglycaemia
OT  - Hyperosmolar hyperglycaemic state
OT  - Insulin
OT  - Japan
OT  - Ketones (plasma)
OT  - Male
OT  - March
OT  - Paediatric endocrinology
OT  - Paediatrics
OT  - Pancreas
OT  - Polydipsia
OT  - Polyuria
OT  - Saline
OT  - Ultrasound scan
OT  - Unique/unexpected symptoms or presentations of a disease
OT  - Weight
OT  - Weight loss
EDAT- 2019/03/06 06:00
MHDA- 2019/03/06 06:00
PMCR- 2019/03/05
CRDT- 2019/03/06 06:00
PHST- 2019/02/08 00:00 [received]
PHST- 2019/02/13 00:00 [accepted]
PHST- 2019/03/06 06:00 [entrez]
PHST- 2019/03/06 06:00 [pubmed]
PHST- 2019/03/06 06:00 [medline]
PHST- 2019/03/05 00:00 [pmc-release]
AID - EDM180131 [pii]
AID - 10.1530/EDM-18-0131 [doi]
PST - aheadofprint
SO  - Endocrinol Diabetes Metab Case Rep. 2019 Mar 5;2019:18-0131. doi: 
      10.1530/EDM-18-0131.