title: A child with altered sensorium, hyperglycemia, and elevated troponins.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are potentially life-threatening complications of diabetes mellitus. Although DKA and HHS share similar features, they are distinct clinical entities requiring different treatment measures.
  
  
  OBJECTIVE
  This case illustrates that the clinical distinction between these two entities can be difficult at times, especially in children who can present with an overlapping picture.
  
  
  METHODS
  We report an interesting case of a 12-year-old whose initial presentation of diabetes was a mixed picture of hyperosmolar DKA and HHS coma complicated by myocardial strain and acute renal insufficiency. The myocardial strain resolved completely with resolution of the metabolic abnormalities.
  
  
  CONCLUSIONS
  Emergency physicians should be cognizant of varied presentations of hyperglycemic emergencies in children to initiate appropriate management for better outcomes.
authors.affiliation: Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Rajan
authors.initials: R
authors.lastname: Arora
authors.affiliation: Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Chiwane
authors.affiliation: Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Earl
authors.initials: E
authors.lastname: Hartwig
authors.affiliation: Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Nirupama
authors.initials: N
authors.lastname: Kannikeswaran
mesh_terms: D000208:Acute Disease; D001929:Brain Edema / Q000175:diagnosis; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D008297:Male; D009203:Myocardial Infarction / Q000097:blood; D012307:Risk Factors; D012678:Sensation Disorders / Q000175:diagnosis*; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin
keywords: altered sensorium; children; hyperglycemia; troponin