Hyperosmolar Hyperglycemic State Without Ketosis in a Toddler With Type 1 DiabetesAlharfi, Ibrahim M. MD*†; Singh, Ram MBBS, FRCPC*; Clarson, Cheril BM BS, FRCPC*; Foster, Jennifer R. MD, FRCPC*Pediatric Emergency Care: July 2014 - Volume 30 - Issue 7 - p 485–487 doi: 10.1097/PEC.0000000000000167 Illustrative Cases Abstract Author Information We present a thin toddler whose initial presentation with type 1 diabetes was hyperglycemic hyperosmolar syndrome without diabetic ketoacidosis after ingestion of copious quantities of high-sugar beverages. Increasing consumption of high-sugar beverages may make this presentation of type 1 diabetes mellitus more common. Emergency care physicians must be aware of this potential clinical constellation in the very young, as management differs significantly from that accepted for diabetic ketoacidosis in children. From the *Department of Pediatrics, Western University, London, Ontario, Canada; and †Department of Pediatric Critical Care, King Fahad Medical City, Riyadh, Saudi Arabia. Disclosure: The authors declare no conflict of interest. Reprints: Jennifer R. Foster, MD, FRCPC, C2-845, Division of Pediatric Critical Care, Children’s Hospital, London Health Sciences Center, London, Ontario, N6A5W9 (e-mail: Jennifer.email@example.com). © 2014 Lippincott Williams & Wilkins, Inc.