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December 1974

Hyperglycemia Without Ketosis or Hypernatremia

Am J Dis Child. 1974;128(6):885. doi:10.1001/archpedi.1974.02110310133025

In hyperosmolar dehydration due to enteric disease, hyperglycemia may occur with or without elevation of the serum acetone level or sodium level or both.1 The following case reemphasizes the importance of recognizing this transient abnormality and of treatment by hydration alone. The use of insulin is contraindicated.2

Report of a Case.—An 11-month-old, prematurely born twin boy was hospitalized following one week of fever and gastroenteritis. He had continued taking skim milk and baby food. Family history of diabetes was denied.

Physical examination showed a temperature of 40.6 C (105.1 F); pulse rate, 160 beats per minute; respiration rate, 40/minute; weight, 6.07 kg (13.4 lb) (1.5-kg [3.3-lb] loss in three weeks). He was listless and cyanotic, and he had a weak, ineffectual cough. Skin turgor was poor, eyes were sunken, and rhonchi were heard at the left lung base.

Attempts at intravenous hydration were largely unsuccessful, and during

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