Abstract
Hyperglycemic crisis is life threatening condition in diabetic patients. Traditionally, diabetic ketoacidosis (DKA) has been associated with decompensated type 1 diabetes (T1D) and Hyperosmolar Hyperglycemic State (HHS) became a hallmark of type 2 diabetes (T2D). However, DKA is increasingly being reported in patients with T2D. We reported a case of DKA with some features of HHS, as an initial presentation, in a boy with unknown T2D at young age. Prompt diagnosis and acute critical care approach were very challenging to improve the outcome.
Highlights
We reported a case of diabetic ketoacidosis (DKA) with some features of Hyperosmolar Hyperglycemic State (HHS), as an initial presentation, in a boy with unknown type 2 diabetes (T2D) at young age
Hyperglycemic crisis is an extreme manifestation of decompensated diabetes mellitus, which includes 2 spectrums of clinical states namely Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS)
These 2 manifestations can occur in patients with both type 1 (T1D) as well as type 2 (T2D) diabetes mellitus [1]
Summary
Hyperglycemic crisis is an extreme manifestation of decompensated diabetes mellitus, which includes 2 spectrums of clinical states namely Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS). Physical examination in the Emergency room showed that the patient was in decrease of consciousness with Glasgow Coma Scale (GCS) of 11/15 and very dehydrated He was found with body temperature of 38 °C, normal blood pressure (100/70 mmHg), tachycardia (127 X/min), Kussmaull. Type of breathing (38 X/min), warm extremities with normal capillary refill time, and oxygen saturation of 98% in room air His glucose level was too high to be detected with capillary glucometer. Electrolyte, and pH were totally under controlled (Table 1) on the 7th day in the PICU, as he regained his consciousness He was extubated on day 10 of admission and was on full oral diet. Combination therapeutics of single dose daily long-acting insulin and metformin have shown to be effective in controlling the blood glucose level in this patient
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