Combination of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State in Children with Type 1 Diabetes Mellitus

Abstract Type 1 diabetes mellitus is a common chronic metabolic disorder in children, characterized by persistent hyperglycemia resulting from absolute insulin deficiency. Delayed or incorrect diagnosis may result in life-threatening complications such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Although distinct, these conditions may co-exist, increasing mortality risk and complicating management. We report a 15-year-old girl who presented with altered consciousness (Glasgow Coma Scale 1-2-4), nausea, vomiting, and shortness of breath. Laboratory findings revealed hyperglycemia (>600 mg/dL), hypokalemia, ketonuria, metabolic acidosis, and elevated serum osmolarity (334.385 mOsm/L). Combined DKA and HHS were diagnosed, supported by ketonuria, acidosis, severe hyperglycemia, and hyperosmolarity. The patient was managed with intravenous fluids, potassium chloride, insulin, meropenem, and sodium bicarbonate, and was admitted to the intensive care unit. She clinically improved by day 7 and was discharged. This case highlights the importance of early recognition and prompt management of DKA with HHS to improve outcomes.