Hyperosmolar hyperglycemic state of pregnancy with intrauterine fetal demise and Preeclampsia

Hyperosmolar hyperglycemic state (HHS) is a serious complication of uncontrolled hyperglycemia. Paralleling the obesity epidemic, the incidence of type 2 diabetes is increasing in a younger population. Therefore, obstetricians must be prepared to deal with the complications of this disease. We present a unique case of new-onset diabetes resulting in HHS. A 21-year-old G1P0 presented at 32 weeks 2 days with an intrauterine fetal demise. At presentation, she was noted to have hyperglycemia, hypertension, proteinuria, altered sensorium, and negative serum ketones. Management included an insulin drip, rehydration, and magnesium. Labor was induced without complications. HHS secondary to undiagnosed type 2 diabetes may become a more common entity in the pregnant population as obesity reaches epidemic proportions. The practitioner should have a high index of suspicion for HHS in obese patients presenting with hyperglycemia.