Successful Management of Extreme Hyperglycemia (134 mmol/L) Secondary to Chronic Pancreatitis Causing Critical Hyperosmolar Coma: A Case Report

TL;DR

A man with diabetes and chronic pancreatitis experienced extreme high blood sugar and coma but recovered after intensive treatment.

Contribution

This case report highlights successful management of a rare and severe hyperglycemic episode in a patient with chronic pancreatitis.

Findings

The patient had a blood glucose level of 134 mmol/L and serum osmolality of 416 mOsm/kg.

Intensive treatment with insulin and fluids led to full recovery without neurological damage.

The case emphasizes the importance of prompt diagnosis and management of hyperosmolar coma.

Abstract

Hyperosmolar hyperglycemic state (HHS) is a life-threatening condition characterized by extreme hyperglycemia, high plasma osmolality, and severe dehydration without significant ketoacidosis. Prompt diagnosis and appropriate management are essential to reduce morbidity and mortality, which range from 10% to 20%. We report a case of a 50-year-old man with insulin-dependent diabetes mellitus secondary to chronic alcoholic pancreatitis presenting with severe HHS and coma. His initial blood glucose level was 134 mmol/L (2420 mg/dL), and serum osmolality was 416 mOsm/kg. Despite the critical condition at admission, the patient responded well to intensive therapy, including insulin infusion and intravenous fluids, and could be discharged without any neurological sequelae.

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