This 35-year-old man, intubated in the intensive care unit, with hyperosmolar hyperglycemic state secondary to diabetes mellitus type 2, developed white, velvety plaques on his tongue. He was diagnosed with thrush, a condition caused by the fungus Candida albicans. Saliva inhibits the growth of Candida, so a dryer mouth predisposes to Candida growth. Uncontrolled diabetics are more prone to developing thrush because their saliva contains a higher glucose concentration and Candida albicans thrives in sugary environments. Aside from blood glucose control, adults can be treated with a “swish and swallow” nystatin suspension in a dose of 5ml (500,000 units) four times daily, a clotrimazole troche dissolved in the mouth five times daily for 1-2 weeks, a “swish and swallow” itraconazole solution in a dose of 10ml (100mg) twice daily, or with systemic therapies including fluconazole 100mg by mouth daily, or ketoconazole 200mg by mouth daily.
