Stress Induced Hyperglycemia Mimicking Hyperosmolar Hyperglycemic Syndrome In Acute Kidney Injury -Case Report

Abstract The present case is a 40 year adult who presented with fever and headache since three days, vomiting since two days and seizures one day. His capillary blood sugar was >600 mg/dL. Provisionally diagnosed as diabetic ketoacidosis (DKA). But his urine was negative for ketones and blood P H was 7.3 with bicarbonate of 21 mEq/L. His blood urea 124 mg/dL and creatinine 2.7 mg/dL. Diagnosis revised as hyperosmolar hyperglycemic syndrome (HHS) and managed with full recovery. Even though HbA1c was 4.8, in view of HHS started on oral metformin. During the follow up he had hypoglycemic episodes, therefore metformin was stopped. His blood sugars were normal, serum creatinine persistently elevated, and renal biopsy revealed acute tubulointerstitial nephritis (ATIN). After 6 months he was prediabetic (HbA1c was 5.9). Diagnosis revised as stress induced hyperglycemia (SIH) in acute kidney injury (AKI) due to infection. This report intends to raise awareness regarding SIH, which can mimic HHS; is a risk factor for pre-diabetes.