Zubkiewicz-Kucharska Agnieszka, Chrzanowska Joanna, Noczyńska Anna
Department of Endocrinology and Diabetology for Children and Adolescents, Wrocław Medical University, Poland.
Pediatr Endocrinol Diabetes Metab. 2019;25(2):85-89. doi: 10.5114/pedm.2019.85819.
Hyperglycaemic hyperosmolar state (HHS) may occur in young patients with type 1 and type 2 diabetes and in infants with hyperglycaemia. Hyperglycaemic hyperosmolar state is characterised by extremely high glucose concentration, which, by increasing osmotic diuresis, intensifies dehydration. Hyperglycaemic hyperosmolar state criteria include the following: plasma glucose > 600 mg/dl, venous pH > 7.25, sodium bicarbonate > 15 mmol/l, slight ketonuria, plasma osmolality > 320 mOsm/kg, and impairment of consciousness (aggression, unconsciousness, convulsions). We describe the case of a 13-year-old patient with severe obesity (at presentation body mass > 120 kg, BMI > 40 kg/m2), who developed HHS (glycaemia 647 mg/dl, pH 7.18, pCO2 96.5 mmHg, BE - 5.0 mmol/l, HCO3 35.2 mmol/l; Na 167 mmol/l, plasma osmolarity 370 mOsm/kg) in the course of pneumonia and newly diagnosed type 2 diabetes (HbA1c 15.5%, C-peptide 2.63 ng/ml). In the follow-up, due to the hypoglycaemia, insulin was discontinued, metformin was administered at a dose of 2 g/day, with a further reduction to 500 mg/day, together with physical rehabilitation and a low-calorie diet. Weight reduction during 6 months of observation was approximately 37 kg. Due to breathing disorders occurring at night, the girl still needs breathing assistance (CPAP).
高血糖高渗状态（HHS）可能发生在1型和2型糖尿病的年轻患者以及高血糖的婴儿中。高血糖高渗状态的特征是血糖浓度极高，通过增加渗透性利尿，加剧脱水。高血糖高渗状态的标准包括：血浆葡萄糖>600mg/dl，静脉血pH>7.25，碳酸氢钠>15mmol/l，轻微酮尿，血浆渗透压>320mOsm/kg，以及意识障碍（攻击行为、昏迷、抽搐）。我们描述了一名13岁严重肥胖患者（就诊时体重>120kg，BMI>40kg/m²）的病例，该患者在肺炎病程中并发HHS（血糖647mg/dl，pH7.18，pCO₂96.5mmHg，碱剩余-5.0mmol/l，HCO₃35.2mmol/l；钠167mmol/l，血浆渗透压370mOsm/kg），且新诊断为2型糖尿病（糖化血红蛋白15.5%，C肽2.63ng/ml）。在随访中，由于低血糖，停用了胰岛素，给予二甲双胍，剂量为2g/天，后减至500mg/天，同时进行身体康复和低热量饮食。在6个月的观察期内体重减轻约37kg。由于夜间出现呼吸障碍，该女孩仍需要呼吸辅助（持续气道正压通气）。
