A real sugar high? Wheeze and associated hyperglycemia

We present the case of a 13-month-old boy who initially presented with a 2-day history of cough and coryzal symptoms with significant wheeze and a respiratory acidosis. His viral-induced wheeze was initially treated with nebulized salbutamol and oral prednisolone, but then, he went on to develop hyperglycemia, ketonuria, and glycosuria with a partially compensated metabolic acidosis. We discuss the differential diagnoses of salbutamol-induced lactic acidosis, steroid-induced hyperglycemia, new presentation of diabetic ketoacidosis, or transient hyperglycemia. We then focus on transient hyperglycemia and the risk of the progression of this clinical entity to insulin-dependent diabetes mellitus.