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Hyperosmolar hyperglycaemic state — MCCQE Part 1 MCQ

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HardAltered Level of ConsciousnessHyperosmolar hyperglycaemic stateMCCQE Part 1

A 77-year-old man with type 2 diabetes is brought in confused after several days of polyuria and poor intake. Glucose is 48 mmol/L, effective osmolality is high, pH is 7.36 and ketones are minimal. Which of the following is the most likely diagnosis?

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Correct answer: C — Hyperosmolar hyperglycaemic state

Severe hyperglycaemia, dehydration, altered mental status, high osmolality and minimal ketosis are typical of hyperosmolar hyperglycaemic state. DKA has prominent ketosis and acidosis, while alcoholic ketoacidosis usually has lower or normal glucose. HHS requires slow correction of dehydration and careful electrolyte monitoring, often in hospital.

Reference: Diabetes Canada Clinical Practice Guidelines