Abstract
Hyperosmolar hyperglycemic syndrome (HHS) is a common complication of diabetes mellitus. The episodes of HHS have been reported in patients with no prior history of diabetes. However, these incidents have rarely been reported in the literature. The present study reports the case of hyperosmolar hyperglycemic syndrome in a patient without diabetes history after being prescribed high-dose steroid therapy. This case highlights the importance of regularly monitoring blood glucose levels in patients prescribed supraphysiological doses of steroids. The present study presents a 29-year-old male patient with no previous history of diabetes who presented with HHS, manifested by a decreased level of consciousness, lethargy, and history of polyuria. Laboratory work revealed significantly high serum glucose and high serum osmolality, with no ketones. Two weeks prior to the presentation, the patient was started on 1 mg/kg of oral prednisolone for his new diagnosis of minimal change disease with a nephrotic syndrome picture. The management of HHS included aggressive fluid intake and insulin therapy, and the steroid was tapered quickly. Hyperglycemia resolved completely with normalization of his HbA1c after the complete stoppage of steroids and he did not require to continue lifelong insulin. The present study highlights the importance of assessing the risk of hyperglycemia, screening, and regular glucose monitoring in patients prescribed supraphysiological doses of steroids, even if no prior history of diabetes has been recorded..