Which features distinguish hyperosmolar hyperglycemic state (HHS) from diabetic ketoacidosis?

Which features distinguish hyperosmolar hyperglycemic state (HHS) from diabetic ketoacidosis?

• A. Glucose >600 mg/dL, high serum osmolality, little to no ketones, minimal acidosis (pH >7.3) and more dehydration.
• B. Glucose >600 mg/dL with severe acidosis and high ketones.
• C. Glucose <300 mg/dL with low osmolality.
• D. Ketones present, acidosis severe.

Answer: (A)

HHS is defined by very high blood glucose with pronounced dehydration and a high effective osmolality, but with little to no ketoacidosis. The insulin level is enough to suppress ketone production, so ketones are minimal and the acid-base disturbance is mild or absent (pH typically above 7.3). The extreme hyperglycemia drives osmotic diuresis, leading to substantial fluid loss and higher osmolality. That’s why the best choice describes glucose often over 600 mg/dL, high serum osmolality, little to no ketones, only minimal acidosis, and more dehydration. In contrast, diabetic ketoacidosis features significant ketosis and metabolic acidosis (pH < 7.3, bicarbonate low) with variable glucose that is usually not as extremely high, and dehydration is present but not to the same extent as in HHS.

HHS is defined by very high blood glucose with pronounced dehydration and a high effective osmolality, but with little to no ketoacidosis. The insulin level is enough to suppress ketone production, so ketones are minimal and the acid-base disturbance is mild or absent (pH typically above 7.3). The extreme hyperglycemia drives osmotic diuresis, leading to substantial fluid loss and higher osmolality.

That’s why the best choice describes glucose often over 600 mg/dL, high serum osmolality, little to no ketones, only minimal acidosis, and more dehydration. In contrast, diabetic ketoacidosis features significant ketosis and metabolic acidosis (pH < 7.3, bicarbonate low) with variable glucose that is usually not as extremely high, and dehydration is present but not to the same extent as in HHS.