title: Type 2 diabetes presenting with hyperglycaemic hyperosmolar state in an adolescent renal transplant patient.
abstract: Hyperglycaemic hyperosmolar state (HHS) is a life-threatening condition rarely seen in paediatrics. It is becoming increasingly recognised with the growing incidence of childhood type 2 diabetes mellitus (T2DM). We present a 16-year-old boy with Bardet-Biedl syndrome, with comorbidities including chronic renal impairment requiring renal transplant, isolated growth hormone (GH) deficiency and obesity, who presented on routine follow-up with new onset T2DM and in HHS. Investigations revealed hyperglycaemia (45.7 mmol/L), ketones of 0.1 mmol/L, pH 7.38 and osmolarity 311 mOsmol/kg. After acute management with fluid resuscitation and intravenous insulin, he is now stable on metformin. He has lost weight, renal function is stable and he has stopped GH therapy. We discuss the dilemmas encountered in his long-term management due to his renal transplant and comorbidities, and whether or not, given his significant T2DM risk, this case was preventable or predictable.
authors.affiliation: Department of Paediatrics, Royal United Hospital, Bath, Somerset, UK.
authors.forename: Francesca Ruth
authors.initials: FR
authors.lastname: Harrington
authors.affiliation: Department of Paediatrics, Royal Berkshire Hospital, Reading, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Wolfenden
authors.affiliation: Department of Diabetes & Endocrinology, Oxford Children's Hospital, Oxford, UK.
authors.forename: Tafadzwa
authors.initials: T
authors.lastname: Makaya
mesh_terms: D061605:Administration, Intravenous / Q000379:methods; D000293:Adolescent; D020788:Bardet-Biedl Syndrome / Q000150:complications*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004393:Dwarfism, Pituitary / Q000150:complications*; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D016867:Immunocompromised Host; D033162:Incidental Findings; D007328:Insulin / Q000008:administration & dosage; D016030:Kidney Transplantation; D008297:Male; D009765:Obesity / Q000150:complications; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin