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

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.