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Diabetic ketoacidosis (DKA) is present at diagnosis for about 40% of children with type 1 diabetes mellitus (DM).1 Hyperosmolar hyperglycaemic state (HHS) is another acute complication of DM more typically associated with type 2 DM in adults or adolescents. Recent evidence indicates that a mixed picture of HHS and DKA also occurs in children with type 1 DM2 but it is not frequently reported and therefore...