title: A new challenge in pediatric obesity: pediatric hyperglycemic hyperosmolar syndrome.
abstract: OBJECTIVE
  To describe four adolescents with hyperglycemic hyperosmolar syndrome, an uncommon presentation of type 2 diabetes in pediatric patients.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Two tertiary pediatric intensive care units in university teaching hospitals.
  
  
  METHODS
  Four obese adolescents with hyperglycemic hyperosmolar syndrome associated with type 2 diabetes mellitus.
  
  
  METHODS
  Isotonic fluid resuscitation and insulin.
  
  
  RESULTS
  Two of the four patients died. The first patient died within the first 24 hrs of hyperglycemic hyperosmolar syndrome presumably due to hypovolemic shock. The second patient, who died, developed rhabdomyolysis and multiple-system organ failure after a prolonged intensive care unit stay. The third and fourth patients were discharged from the hospital in good health. None of the patients had cerebral edema on head computed tomography, despite differences in fluid and insulin management.
  
  
  CONCLUSIONS
  Pediatric patients with hyperglycemic hyperosmolar syndrome have a high mortality rate and may experience multiple complications such as rhabdomyolysis and hypovolemic shock. Treatment strategies to reduce mortality are unclear and warrant further investigation.
authors.affiliation: Pediatric Critical Care Fellow, University of North Carolina Hospital, Chapel Hill, NC, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Carchman
authors.forename: Martha
authors.initials: M
authors.lastname: Dechert-Zeger
authors.forename: Ali S
authors.initials: AS
authors.lastname: Calikoglu
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Harris
mesh_terms: D000138:Acidosis; D000293:Adolescent; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D005440:Fluid Therapy; D006784:Hospitals, Teaching; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D007328:Insulin / Q000627:therapeutic use; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D009765:Obesity / Q000150:complications*; D012206:Rhabdomyolysis / Q000209:etiology; D012769:Shock / Q000209:etiology; D013577:Syndrome
chemical_list: D007328:Insulin; D007552:Isotonic Solutions