8362 3 cases with Hyperosmolar Hyperglycemic Syndrome and Atypical Diabetic Ketoacidosis

Abstract Disclosure: C. Nakamura: None. M. Ishimaru: None. E. Tanimoto: None. S. Fukui: None. N. Ujita: None. H. Miyagi: None. M. Igarashi: None. T. Kashima: None. H. Doi: None. K. Yoshii: None. Y. Naiki: None. R. Horikawa: None. Introduction: Diabetic ketoacidosis (DKA) and hyperosmotic hyperglycemia syndrome (HHS) are severe hyperglycemic emergencies as the spectrum of insulin deficiency and dehydration. HHS is known as a complication with type 2 diabetes mellitus(T2DM), likely to develop in elderly patients with hypertension and cardiac disease triggered by infections in Japan. In children and adolescents, as the incidence of T2DM rises, HHS is increasing. HHS and/or DKA cases in type 1 diabetes mellitus (T1DM) also have been reported, but it is not yet clear in which cases are more likely to develop. Clinical Cases Case 1> An 18-year-old girl with central diabetes insipidus and T2DM after operation for suprasellar germ cell tumor. She tended to neglect medication of desmopressin. She presented to the emergency department with fatigue, and had 6.6% weight loss in 1 week. Lab: Blood glucose 669 mg/dl, pH 7.306, b-hydroxybutyrate 1.3 mmol/L, Na 153 mEq/L, plasma osmolality 359 mOsm/kgH2O. She was diagnosed as HHS and needed enough hydration. > She was receiving artificial respiration and gastric tube feeding. She was brought to the emergency room with fever and hypoxemia, and she had lost 9.6% of weight in 2 weeks. Lab: Blood glucose 1322 mg/dl, pH 7.13, b-hydroxybutyrate 6.2 mmol/L, Na 160 mEq/L, plasma osmolality 446 mOsm/kgH2O. She was diagnosed as DKA and HHS combined with T1DM. She required enough hydration than usual treatment of DKA. Case 3> A 17-year-old boy with Prader-Willi syndrome. He presented to the emergency department with persistent low-grade fever and had 9.4% weight loss in 1 week. Lab: Blood glucose 519 mg/dl, pH 7.24, b-hydroxybutyrate 6.0 mmol/L, Na 136 mEq/L, plasma osmolality 334 mOsm/kgH2O. In addition to initial DKA treatment, he required aggressive dehydration correction with consideration of HHS. Clinical Lesson Three cases had underlying diseases that made it difficult for them to hydrate appropriately. They were easily dehydrated, and were high risk of developing/complicating HHS. In emergency hyperglycemia cases in children and young adults with those underlying diseases, we have to consider the possibility of the pathophysiology of both DKA and HHS at an early stage of treatment. Some symptoms which are not typical for DKA, like hypernatremia or abnormally high serum osmolality, the possibility of HHS should be considered. Presentation: 6/1/2024