title: [Pediatric hyperglycemic hyperosmolar coma diabeticum: diagnostic evaluation and therapeutic concept].
abstract: Hyperglycemic hyperosmolar coma diabeticum (HHS) is a rare phenomenon in pediatric patients. It causes major morbidity and significant mortality. It is characterized by the trias of hyperglycemia, hyperosmolality and absent or mild metabolic acidosis. Major complications include cerebral edema and rhabdomyolysis. Evidence based guidelines for HHS in children are lacking. Based on a literature review we discuss treatment options in pediatric HHS und suggest a therapeutic concept. Appropriate treatment consists of adequate fluid administration and a cautious lowering of the serum glucose level. Patients should be treated on an intensive care unit and monitored closely to avoid complications. Low-dose and late insulin administration seems to be favourable.
authors.affiliation: Pädiatrische Endokrinologie und Diabetologie, Universitätskinderklinik Bonn, Germany. joachim.woelfl e@ukb.uni-bonn.de
authors.forename: J
authors.initials: J
authors.lastname: Wetter
authors.forename: B C
authors.initials: BC
authors.lastname: Gohlke
authors.forename: S
authors.initials: S
authors.lastname: Stutte
authors.forename: J F
authors.initials: JF
authors.lastname: Woelfle
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003131:Combined Modality Therapy; D003422:Critical Care; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005440:Fluid Therapy; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000097:blood; D007552:Isotonic Solutions / Q000008:administration & dosage; D008066:Lipolysis / Q000502:physiology; D000077325:Ringer's Lactate; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage; D015996:Survival Rate; D013927:Thrombosis / Q000517:prevention & control; D014882:Water-Electrolyte Balance / Q000502:physiology
chemical_list: D001786:Blood Glucose; D007328:Insulin; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride