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Hyperosmolar hyperglycaemic state — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesHyperosmolar hyperglycaemic stateSCE Acute Medicine

A 63-year-old woman presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show glucose 48, osmolality 342, minimal ketones and severe dehydration. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Start cautious intravenous fluid replacement before insulin unless ketonaemia is significant

The key discriminator is that glucose 48, osmolality 342, minimal ketones and severe dehydration, which makes Start cautious intravenous fluid replacement before insulin unless ketonaemia is significant the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Give intravenous fluids with reassessment and Call critical care for escalation are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: JBDS HHS guideline