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Hyperosmolar hyperglycemic state — ABEM Board MCQ

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ModerateRenal/Metabolic emergenciesHyperosmolar hyperglycemic stateABEM Board

A 71-year-old man with type 2 diabetes arrives confused after several days of polyuria. Triage acuity is ESI 2; BP 86/50 mm Hg, HR 124/min. Glucose is 982 mg/dL, serum osmolality is 340 mOsm/kg, pH is 7.34, and ketones are trace. Which of the following is the most appropriate disposition?

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

Reveal the answer and explanation

Correct answer: C — Admit for aggressive IV fluids, electrolyte monitoring, and insulin therapy

HHS causes severe dehydration and altered mental status and requires inpatient management with fluids, electrolytes, and insulin.

Reference: ADA hyperglycemic crises guidance