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Hyperosmolar hyperglycaemic state — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesHyperosmolar hyperglycaemic stateSCE Acute Medicine

A 79-year-old woman is assessed on the acute medical unit. She has type 2 diabetes, profound dehydration and confusion. Glucose is 48 mmol/L, osmolality 342 mOsm/kg, ketones 0.8 mmol/L and pH 7.36. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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

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Correct answer: A — Give isotonic crystalloid boluses with frequent reassessment

Give isotonic crystalloid boluses with frequent reassessment is the best answer because HHS treatment prioritises careful fluid replacement; insulin is delayed unless ketonaemia is significant. Give intramuscular adrenaline 500 micrograms is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Rapid osmolar shifts can harm older patients with HHS.

Reference: JBDS HHS guideline