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Hyperosmolar hyperglycemic state — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Hyperosmolar hyperglycemic stateUSMLE Step 3

A 71-year-old man with type 2 diabetes has confusion and dehydration after 1 week of polyuria. Glucose is 812 mg/dL, pH is 7.36, bicarbonate is 22 mEq/L, and serum osmolality is elevated. Which of the following is the most likely diagnosis?

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Reveal the answer and explanation

Correct answer: A — Hyperosmolar hyperglycemic state

Severe hyperglycemia, dehydration, high osmolality, and minimal acidosis support hyperosmolar hyperglycemic state.

Reference: American Diabetes Association Standards of Care in Diabetes—2026