SUN-168 HAART-Induced Hyperglycemic Hyperosmolar Syndrome: A Rare Manifestation of HAART Therapy

Abstract

Methods: Analysis of case report Objective: Increase awareness of Hyperglycemic complications secondary to HAART therapy) : 59-year-Old Hispanic Male with past medical History of pre-diabetes and recently diagnosed with HIV presented to the Emergency Department with the complaint of fatigue for 3 days associated with nausea for same duration. He denied any other complaints. Patient's blood glucose was 1900 mg/dl, serum bicarbonate level: 22, Blood pH: 7.38, serum acetone negative, and urine ketones negative. Serum osmolarity was 340 mmol/kg and HBA1c was 19%. Based on above laboratory Values, Diagnosis of Hyperglycemic Hyperosmolar Syndrome (HHS), was made and patient was admitted to Medical ICU started with Intravenous (IV) fluids and IV insulin Infusion. After normalization of blood sugar, patient transferred to the medical floor and provided with diabetic teaching and started on subcutaneous Insulin Injection. On review of past medical history, patient was diagnosed with HIV 6 weeks ago and was started with HAART therapy containing a Protease inhibitor (ritonavir) as one of drug in the combination therapy. Blood work 8 weeks ago showed HAB1C 6.2% and blood glucose 115 mg/dl showing temporal relation of the start of HAART therapy and sudden change in blood glucose and increased HBA1c. Infectious disease team was consulted and patient's HIV regimen was switched and Protease inhibitor ( Ritonavir) was stopped, Patient was discharged with a new HAART therapy and also subcutaneous Insulin. We followed the patient closely in outpatient management and over the course of 3 months, HBA1C and blood sugar came back to baseline and subcutaneous insulin was stopped. Conclusion 1. Protease inhibitors are commonly associated with Metabolic Syndrome. This is first case to our best of knowledge in which protease inhibitors has been linked to pure Hyperglycemic Hyperosmolar Syndrome. 2. Patients starting with HAART therapy should be further investigated for possible hyperglycemia secondary to protease Inhibitors. Abbreviation: HHS: Hyperglycemic Hyperosmolar Syndrome HAART: Highly Active Anti-Retroviral Therapy MICU: Medical Intensive Care Unit IVF: Intravenous Fluids