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Hyperglycaemic hyperosmolar state: first presentation of type 1 diabetes mellitus in an adolescent with complex medical needs
  1. Kene Ebuka Maduemem1,2,
  2. Omotayo Adesanya2,
  3. Obinna O Anuruegbe2 and
  4. Anjum Rafiq2
  1. 1College of Medicine and Veterinary Medicine, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, Edinburgh, UK
  2. 2Paediatrics, Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
  1. Correspondence to Kene Ebuka Maduemem; ebukakene{at}


This is a case of hyperglycaemic hyperosmolar state (HHS) as first presentation of type 1 diabetes mellitus in a 14-year-old girl with background complex medical needs. She presented with marked hyperglycaemia (56 mmol/L) without significant ketonaemia (2.6 mmol/L) and serum hyperosmolality (426 mOsm/kg). Managing her profound hypernatraemic (>180 mmol/L) dehydration was challenging but resulted in good outcome. Paediatric patients with HHS will likely be treated with the diabetes ketoacidosis (DKA) protocol because of perceived rarity of HHS leading to inadequate rehydration and risk of vascular collapse. Hence, emphasis on the differences in the management protocols of DKA and HHS is paramount. Prompt recognition and adequate management are crucial to avert complications. The undesirable rate of decline of hypernatraemia due to the use of hypotonic fluid was captured in this case. We describe the pivotal role of liberal fluid therapy with non-hypotonic fluids.

  • diabetes
  • cerebral palsy
  • fluid electrolyte and acid–base disturbances

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  • Contributors KEM conceived and drafted the manuscript. OA and OOA contributed substantially to the manuscript draft and editing process. AR was the responsible consultant of the patient’s care and reviewed the manuscript. All authors approved the submitted version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.