Hyperglycaemic hyperosmolar state and cerebral thrombophlebitis in paediatrics: A case report. Issue 2 (1st February 2023)

• Record Type: Journal Article
• Authors: Injeyan, Maud; Baron, Sabine; Lauzier, Benjamin; Gaillard‐Le Roux, Benedicte; Denis, Manon
• Is Part Of: Endocrinology, diabetes & metabolism. Volume 6:Issue 2(2023)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2023-02-01
• Subjects: case report -- cerebral thrombophlebitis -- diabetes -- hyperglycaemic hyperosmolar state; Endocrinology -- Periodicals; Diabetes -- Periodicals; Metabolism -- Periodicals; 616.4
• DOI: 10.1002/edm2.389
• Languages: English
• ISSNs: 2398-9238

Abstract

Abstract: Introduction: Hyperglycaemic hyperosmolar state (HHS) is a known complication of type 2 diabetes mellitus; however, carbonated carbohydrate fluid intake may precipitate a more severe presentation of type 1 diabetes mellitus with hyperosmolar state. The management of these patients is not easy and can lead to severe complications such as cerebral venous thrombosis. Methods: We present the case of a 21‐month‐old boy admitted for consciousness disorders revealing a hyperglycaemic hyperosmolar state on a new‐onset type 1 diabetes and who developed cerebral venous thrombosis. Results and Conclusion: Emergency physicians should be aware of HHS in order to start the appropriate treatment as early as possible and to monitor the potential associated acute complications. This case highlights the importance of decreasing very gradually the osmolarity in order to avoid cerebral complications. Cerebral venous thrombosis in HHS paediatric patients is rarely described, and it is important to recognize that not all episodes of acute neurological deterioration in HHS or diabetic ketoacidosis are caused by cerebral oedema. Abstract : Emergency physicians should be aware of HHS in order to start the appropriate treatment as soon as possible and to think about its acute complication. This case highlights the importance to restore euvolemia before insulin treatment and decrease very gradually the osmolarity in order to avoid cerebral complication. Cerebral venous thrombosis in HHS paediatric patients is rarely described, and it is important to recognize that not all episodes of acute neurological deterioration in HHS or DKA are caused by cerebral oedema.