Abstract

We present the unique cases of two adolescent patients who presented to a pediatric tertiary care facility in the Midwest United States with newly diagnosed type 2 diabetes mellitus, complicated by the combination of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Each case required intensive therapy with treatment consisting of replacement of fluids over a prolonged period of =>72 hours and careful monitoring of electrolyte response. Complications included acute renal failure, superficial thrombosis, and rhabdomyolysis. The two cases made a complete recovery without neurological sequelae. Both cases highlight the complexity of managing patients with a mixed DKA-HHS presentation and associated morbidities. Implementation of screening guidelines for type 2 diabetes mellitus is vital to prevent such serious complications.

Keywords: Hyperosmolar ; Diabetic; Ketoacidosis