Specific Considerations for Children with HHS Unlike adults, pediatric patients may present with no identifiable precipitat- ing factor [33]. Children with HHS also have a greater degree of dehydration than those in DKA, although the signs and symptoms of dehydration may be less clinically evident [34••]. Some children may present with a mixed picture of DKA and HSS, making management more challenging [35]. The potential complications of HHS are also distinct from those in DKA and include increased risk of thromboembo- lism,rhabdomyolysis,andamalignanthyperthermia-likesyn- drome [34••].