Combined Hyperglycemic Hyperosmolar Syndrome and Diabetic Ketoacidosis Associated with COVID-19 in a Pediatric Patient

Although most children with coronavirus disease 2019 (COVID-19) are asymptomatic or only with mild symptoms, many symptomatic children still require admission to the intensive care unit. Multiple cases of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) associated with COVID-19 have been reported in adults. However, to our knowledge, only few similar cases have been published in the pediatric population. We report one of the first few severe cases of mixed HHS with DKA associated with COVID-19 in an adolescent. Our patient was successfully treated with intravenous immunoglobulin, Remdesivir, and methylprednisolone. As the pandemic continues, clinicians should be aware of this syndrome and consider early use of Remdesivir and corticosteroids. Further studies are required to understand the pathophysiology of this syndrome occurring with COVID-19.

Hyperchloremic Metabolic Acidosis with Hyperglycemic Hyperosmolar Syndrome after Robot-Assisted Radical Cystoprostatectomy with Ileal Conduit Urinary Diversion: A Case Report

Hyperchloremic metabolic acidosis can be a problem in urinary diversion using the ileum. A 73-year-old Japanese male was hospitalized in emergency due to anorexia and malaise 3 weeks after being discharged from the hospital after getting robot-assisted radical cystoprostatectomy and intracorporeal ileal conduit urinary diversion. The blood analysis revealed metabolic acidosis, elevated chloride ions, and marked hyperglycemia: he was diagnosed with hyperchloremic metabolic acidosis and hyperglycemic hyperosmolar syndrome. We started administering insulin and large amounts of fluid replacement; besides, we inserted a large-diameter open tip catheter into the ileal conduit in hopes of inhibiting urine reabsorption in the intestinal mucosa. His general condition gradually improved, and he was discharged 10 days after his hospitalization.

Seasonal Variations of Hyperglycemic Crises in Diabetic Patients at a National Hospital Center, Benin: a Cross Sectional Study

Aim : To study the seasonal characteristics of hyperglycemic decompensations in the endocrinology department of the CNHU-HKM of Cotonou. Materials and methods :It was a cross-sectional, descriptive, and study of diabetic patients hospitalized from January 1, 2010 to December 31, 2019. Diabetic patients hospitalized for ketosis decompensation and/or hyperglycemic hyperosmolar syndrome were included in this study. The meteorological data used were obtained from the climate observation network of the Direction de la Météorologie Nationale (DMN) du Bénin. We have considered the means of rainfall and temperature per month and per year. Results : A total of 613 patients were included during the study period. The mean age of the patients was 46.77±15.84 years. The frequency of hyperglycemic hyperosmolar syndrome and ketoacidosis was 14.7% and 69.5% respectively. Hyperglycemic crises were more frequent during the rainy season and periods of low temperature. The main precipitating factors were infections and non-adherence to treatment. The main infectious sites involved in hyperglycemic crises were pulmonary (19%), urogenital (21.3%) and malaria (26.8%). The frequency of these different infections was higher during the rainy season with a statistically significant difference (p=0.02) for malaria. Conclusion : The frequency of hyperglycemic crises was high and had a seasonal distribution. The most frequent precipitating factors were infections and non-adherence to treatment. Those factors were more frequent in the rainy season.

A Complicated Case of COVID-19 and Hyperglycemic Hyperosmolar Syndrome in an Adolescent Male

Emerging data demonstrate that comorbid conditions and older age are contributing factors to COVID-19 severity in children. Studies involving youth with COVID-19 and diabetes are lacking. We report the case of a critically ill adolescent male with obesity, type 2 diabetes, and COVID-19 who presented with hyperglycemic hyperosmolar syndrome (HHS). This case highlights a challenge for clinicians in distinguishing severe complications of COVID-19 from those seen in HHS. Youth with obesity and type 2 diabetes may represent a high-risk group for severe COVID-19 disease, an entity that to date has been well-recognized in adults but remains rare in children and adolescents.

Hyperglycemic Hyperosmolar Syndrome Presenting with Unique Craniofacial Involuntary Movements

A 54-year-old man, with a twenty-five year history of poorly controlled type 2 diabetes mellitus, presented with 4 days of abnormal movements of the right side of face precipitated by tactile stimulus over his face, upper limbs and trunk. His physical examination revealed right hemifacial spasm precipitated by auditory and tactile stimulus, opsoclonus, blepharospasm, oromandibular dystonia, perioral tremor and myoclonic jerks involving the head and neck particularly triggered by neck extension (video 1,http://links.lww.com/CPJ/A222). The patient also had features of a chronic distal sensory motor neuropathy. He had been unable to take food for nearly 72 hours due to jaw closure dystonia and had developed starvation ketosis.