Abstract
Hyperglycemic hyperosmolar coma diabeticum (HHS) is a rare phenomenon in pediatric patients. It causes major morbidity and significant mortality. It is characterized by the trias of hyperglycemia, hyperosmolality and absent or mild metabolic acidosis. Major complications include cerebral edema and rhabdomyolysis. Evidence based guidelines for HHS in children are lacking. Based on a literature review we discuss treatment options in pediatric HHS und suggest a therapeutic concept. Appropriate treatment consists of adequate fluid administration and a cautious lowering of the serum glucose level. Patients should be treated on an intensive care unit and monitored closely to avoid complications. Low-dose and late insulin administration seems to be favourable.
© Georg Thieme Verlag KG Stuttgart · New York.
MeSH terms
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Adolescent
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Blood Glucose / metabolism
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Child
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Combined Modality Therapy
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Critical Care
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Cross-Sectional Studies
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Diabetes Mellitus, Type 2 / blood
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Diabetes Mellitus, Type 2 / diagnosis
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Diabetes Mellitus, Type 2 / mortality
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Diabetes Mellitus, Type 2 / therapy
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Fluid Therapy
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Humans
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Hyperglycemic Hyperosmolar Nonketotic Coma / blood
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Hyperglycemic Hyperosmolar Nonketotic Coma / diagnosis*
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Hyperglycemic Hyperosmolar Nonketotic Coma / mortality
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Hyperglycemic Hyperosmolar Nonketotic Coma / therapy*
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Infusions, Intravenous
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Insulin / administration & dosage
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Insulin / blood
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Isotonic Solutions / administration & dosage
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Lipolysis / physiology
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Ringer's Lactate
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Risk Factors
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Sodium Chloride / administration & dosage
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Survival Rate
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Thrombosis / prevention & control
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Water-Electrolyte Balance / physiology
Substances
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Blood Glucose
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Insulin
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Isotonic Solutions
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Ringer's Lactate
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Sodium Chloride