{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:22:50Z","timestamp":1789147370924,"version":"build-2803163510"},"reference-count":24,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T00:00:00Z","timestamp":1551744000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,3,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Hyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) are the most severe acute complications of diabetes mellitus (DM). HHS is characterized by severe hyperglycemia and hyperosmolality without significant ketosis and acidosis. A 14-year-old Japanese boy presented at the emergency room with lethargy, polyuria and polydipsia. He belonged to a baseball club team and habitually drank sugar-rich beverages daily. Three weeks earlier, he suffered from lassitude and developed polyuria and polydipsia 1 week later. He had been drinking more sugar-rich isotonic sports drinks (approximately 1000\u20131500\u2009mL\/day) than usual (approximately 500\u2009mL\/day). He presented with HHS (hyperglycemia (1010\u2009mg\/dL, HbA1c 12.3%) and mild hyperosmolality (313\u2009mOsm\/kg)) without acidosis (pH 7.360), severe ketosis (589\u2009\u03bcmol\/L) and ketonuria. He presented HHS in type 1 diabetes mellitus (T1DM) with elevated glutamate decarboxylase antibody and islet antigen 2 antibody. Consuming beverages with high sugar concentrations caused hyperglycemia and further exacerbates thirst, resulting in further beverage consumption. Although he recovered from HHS following intensive transfusion and insulin treatment, he was significantly sensitive to insulin therapy. Even the appropriate amount of insulin may result in dramatically decreasing blood sugar levels in patients with T1DM. We should therefore suspect T1DM in patients with HHS but not those with obesity. Moreover, age, clinical history and body type are helpful for identifying T1DM and HHS. Specifically, drinking an excess of beverages rich in sugars represents a risk of HHS in juvenile\/adolescent T1DM patients.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Hyperglycemic hyperosmolar state (HHS) is characterized by severe hyperglycemia and hyperosmolality without significant ketosis and acidosis.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The discrimination between HHS of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in initial presentation is difficult.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Pediatrician should suspect T1DM in patients with HHS but not obesity.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Age, clinical history and body type are helpful for identifying T1DM and HHS.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Children with T1DM are very sensitive to insulin treatment, and even appropriate amount of insulin may result in dramatically decreasing blood sugar levels.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-18-0131","type":"journal-article","created":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T11:09:17Z","timestamp":1551784157000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":5,"title":["Hyperglycemic hyperosmolar state in an adolescent with type 1 diabetes mellitus"],"prefix":"10.1530","volume":"2019","author":[{"given":"Suguru","family":"Watanabe","sequence":"first","affiliation":[{"name":"1Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan"},{"name":"2Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Kido","sequence":"additional","affiliation":[{"name":"2Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Ogata","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimitoshi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"2Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Mizukami","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref201","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/j.1464-5491.2005.01517.x","article-title":"Childhood diabetes presenting with hyperosmolar dehydration but without ketoacidosis: a report of three cases","volume":"22","year":"2005","journal-title":"Diabetic Medicine"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"671","DOI":"10.2337\/diacare.19.6.671a","article-title":"Diabetic ketoacidosis in young obese Japanese men","volume":"19","year":"1996","journal-title":"Diabetes Care"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/S0140-6736(97)03062-6","article-title":"UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes. 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