Hyperglycemic Emergencies in Minority Children and Adolescents With Diabetes

Mixed presentation of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) has been reported in up to 27% of hyperglycemic emergencies. This 15-year retrospective chart review describes clinical features, risk factors, and outcomes among children presenting with hyperglycemic emergencies at our center. Out of 322 patients, 92% were Afro-Caribbean or Black with a mean age of 13.6 years, comprising 266 (83%) with DKA, 52 (16%) mixed DKA-HHS, and rarely with HHS (1%, n = 4). Most (98%) of DKA and DKA-HHS groups had type 1 diabetes mellitus (T1DM). All 4 patients with HHS had type 2 diabetes mellitus (T2DM). Compared with the DKA group, the mixed DKA-HHS group had higher IV fluid rates (P < .0001), 4.3-fold greater odds of acute kidney injury (AKI), and 3.3-fold greater odds of altered mental status (AMS). In the HHS group, 50% presented had AMS and AKI and required higher IV fluids rates (≥2× maintenance). Clinicians should recognize mixed cases of DKA-HHS to minimize complications.