A Case of Hyperosmolar Hyperglycemic State Caused by Ischemic Pancreatitis

Abstract

Background: The hyperosmolar hyperglycemic state (HHS) is a dangerous complication that can arise with diabetes mellitus. Emergent treatment is necessary to reinstate hemodynamic stability, as mortality rates for HHS are exceptionally high and can have multiple complications.Case Report: A 42-year-old female presented unresponsive to the emergency department. Upon arrival, the patient's examination was consistent with hypovolemia and tachycardia. Review of systems included a one-week history of nausea and vomiting. The patient had stopped all of her medications one year prior, only restarting metformin one week prior to admission. Her presenting systolic blood pressure was 119 mmHg before she developed respiratory failure secondary to a poor mental state. The presenting blood sugar level was 1263 mg/dL, and ketones were not detected in her urine. The patient recovered from her HHS and was discharged in a stable condition.Conclusion: This case study postulates that the patient's excessive nausea and vomiting led to pancreatitis secondary to ischemia, which induced a HHS. This is important because hyperglycemia superimposed on any ischemic insult can increase the risk of multiorgan failure, as with our patient. Thus, recognition and management of resulting complications needs to be emergent.