{
  "abstract": "Hyperosmolar hyperglycemic state (HHS) is an uncommon but life-threatening hyperglycemic emergency in children and is more often associated with type 2 diabetes mellitus. We report a 13-year-old boy with a lean habitus and no previously diagnosed chronic illnesses who presented after three weeks of polyuria, polydipsia, fatigue, and weight loss. On admission, serum glucose was 1,080 mg/dL (60 mmol/L), hemoglobin A1c was 13.8%, measured serum osmolality was 331 mOsm/kg, calculated effective osmolality was 324 mOsm/kg, venous pH was 7.29, bicarbonate was 23.1 mmol/L, beta-hydroxybutyrate was 0.7 mmol/L, and urine ketones were negative. The biochemical profile met pediatric HHS criteria without significant ketoacidosis. He received an initial 20 mL/kg bolus of 0.9% sodium chloride followed by controlled deficit replacement. Intravenous insulin at 0.05 units/kg/hour was deliberately delayed until four hours after the initiation of fluid therapy, when the decline in glucose with fluids alone slowed to <50 mg/dL/hour. Glucose and effective osmolality then declined in a controlled fashion, while measured sodium rose gradually as hyperglycemia corrected; dextrose was added when glucose reached 275 mg/dL. No neurologic, thrombotic, renal, or major electrolyte complications occurred. Strongly positive GAD65 antibodies and a low C-peptide concentration obtained during concurrent hyperglycemia supported autoimmune type 1 diabetes mellitus (T1DM). The patient transitioned to subcutaneous basal-bolus insulin and was discharged on day 3. At three months, hemoglobin A1c was 7.0%. This case illustrates that HHS may be the first manifestation of autoimmune T1DM even in a lean adolescent and emphasizes the importance of interpreting glucose, sodium, and effective osmolality together while prioritizing controlled fluid replacement before insulin.",
  "abstract_shown": true,
  "affiliations": [
    "Pediatric Intensive Care Unit, Almoosa Specialist Hospital, Al-Ahsa, SAU.",
    "Pediatric Intensive Care Unit, King Fahad Medical City, Riyadh, SAU.",
    "Pediatric Critical Care Medicine, Almoosa Specialist Hospital, Al-Ahsa, SAU.",
    "Pediatric Endocrinology, Almoosa Specialist Hospital, Al-Ahsa, SAU.",
    "Pediatrics, Almoosa Specialist Hospital, Al-Ahsa, SAU."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ali T Alamer"
    },
    {
      "affs": [
        1
      ],
      "name": "Sajjad M AlKadhem"
    },
    {
      "affs": [
        0
      ],
      "name": "Osama Kattih"
    },
    {
      "affs": [
        2
      ],
      "name": "Ahmed A Al-Amoudi"
    },
    {
      "affs": [
        3
      ],
      "name": "Aida S AlJabri"
    },
    {
      "affs": [
        4
      ],
      "name": "Zainab M Almeftah"
    },
    {
      "affs": [
        4
      ],
      "name": "Husain A Althani"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4ynrz8ar5qwar.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.116797",
  "fulltext_url": "https://europepmc.org/articles/PMC13694122",
  "id": "4ynrz8ar5qwar",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42921622",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Diabetes Management and Research"
    ]
  ],
  "openalex": "W7214117776",
  "pdf_url": "https://europepmc.org/articles/PMC13694122?pdf=render",
  "pmcid": "PMC13694122",
  "pmid": "42921622",
  "published": "2026-09-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4ynrz8ar5qwar.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:36Z",
      "native_id": "MED:42921622",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42921622"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetes Management and Research",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Hyperosmolar Hyperglycemic State As the Initial Presentation of Type 1 Diabetes Mellitus in an Adolescent: A Case Report.",
  "title_text": "Hyperosmolar Hyperglycemic State As the Initial Presentation of Type 1 Diabetes Mellitus in an Adolescent: A Case Report.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:36Z",
  "url": "https://research.draconitic.com/paper/4ynrz8ar5qwar",
  "venue": "Cureus",
  "versions": []
}