Snapshot A 13-year-old girl with a past medical history of anxiety is brought to the emergency room for nausea, vomiting, and abdominal pain. She is also reports increased urinary frequency. On physical exam, she is lethargic and markedly dehydrated with dry mucous membranes and sunken eyes. Her abdominal exam is benign. Laboratory results show increased serum glucose of 400 mg/dL and hyperkalemia of 4.9 mmol/L. A urinalysis is positive for ketones. She is given fluids and admitted to the intensive care unit for close monitoring and administration of an insulin drip. Introduction Clinical definition login to view 5 more bullets Epidemiology Demographics login to view 1 more bullet etiology Insulin noncompliance Acute medical illness login to view 3 more bullets New-onset diabetes Pathogenesis login to view 1 more bullet Presentation Symptoms login to view 12 more bullets Studies Diagnostic testing login to view 11 more bullets Differential Hyperosmolar hyperglycemic state login to view 3 more bullets DIAGNOSIS Diagnostic criteria login to view 4 more bullets Treatment Management approach login to view 1 more bullet First-line login to view 7 more bullets Complications Mucormycosis login to view 1 more bullet Renal failure Cardiac arrhythmias Cerebral edema login to view 3 more bullets