ESPE Abstracts

Objectives: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are potential life-threatening emergencies of diabetes mellitus (DM). DKA and HHS may coexist, making the treatment difficult. With increasing rates of childhood obesity and pediatric type 2 DM, cases of mixed HHS and DKA are expected to occur more frequently than before. But the frequency and implications of combined DKA/HHS in children/adolescents are not yet well known. We aimed to investigate the frequency and clinical outcomes of children/adolescents with combined DKA/HHS.

Methods: We reviewed all cases admitted between 2009-2021 with diagnosis of DKA or HHS. We determined 1) the frequency of HHS, DKA, and combined DKA/HHS (DKA criteria plus elevated effective osmolality) 2) severity of illness and clinical comorbidities in each group.

Results: There were 199 patients with type 1DM and 149 patients with type 2 DM, of which a total of 86 patients were hospitalized with hyperglycemic crises [type 1DM (n=79) and type 2 DM (n=7)]. Significant portion of patients diagnosed as DKA had combined features of HHS; Eleven (14%) patients with type 1DM and 2 (29%) patients with type2 DM had combined DKA/HHS features. Severe complications in patients with DKA/HHS included acute kidney injury, rhabdomyolysis, thrombocytopenia associated multi-organ failure (TAMOF), and diabetic amyotrophy. In type 1DM patients, combined DKA patients had higher creatinine level (1.20±0.25 vs 0.83±0.30 mg/dl, P<0.001) and longer hospital day (12.5±64.8 vs 8.9±3.5 days, P=0.004) than isolated DKA group.

Conclusions: Combined DKA/HHS can accompany severe complications, and is associated with longer hospital stay compared with isolated DKA. Adequate acute phase management and monitoring of complications are required for these patients.