A new challenge in pediatric obesity: pediatric hyperglycemic hyperosmolar syndrome.

OBJECTIVE

To describe four adolescents with hyperglycemic hyperosmolar syndrome, an uncommon presentation of type 2 diabetes in pediatric patients.

METHODS

Case report.

METHODS

Two tertiary pediatric intensive care units in university teaching hospitals.

METHODS

Four obese adolescents with hyperglycemic hyperosmolar syndrome associated with type 2 diabetes mellitus.

METHODS

Isotonic fluid resuscitation and insulin.

RESULTS

Two of the four patients died. The first patient died within the first 24 hrs of hyperglycemic hyperosmolar syndrome presumably due to hypovolemic shock. The second patient, who died, developed rhabdomyolysis and multiple-system organ failure after a prolonged intensive care unit stay. The third and fourth patients were discharged from the hospital in good health. None of the patients had cerebral edema on head computed tomography, despite differences in fluid and insulin management.

CONCLUSIONS

Pediatric patients with hyperglycemic hyperosmolar syndrome have a high mortality rate and may experience multiple complications such as rhabdomyolysis and hypovolemic shock. Treatment strategies to reduce mortality are unclear and warrant further investigation.