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ModerateEndocrinologyHyperosmolar hyperglycemic stateus-abfmus-abimus-usmle-step-2

A 42-year-old man presents with polyuria, polydipsia, and weight loss over several weeks. Laboratory tests show glucose 620 mg/dL, sodium 130 mEq/L, potassium 4.6 mEq/L, bicarbonate 22 mEq/L, and serum osmolality 320 mOsm/kg. There are no ketones in the urine. What is the most likely diagnosis?

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