skip to main content

Hyperosmolar hyperglycaemic state — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateDiabetes and endocrine medicineHyperosmolar hyperglycaemic stateSCE Acute Medicine

A 73-year-old woman with type 2 diabetes presents with thirst, confusion and reduced urine output after a week of chest infection. Glucose is 48 mmol/L, ketones 0.8 mmol/L, osmolality 338 mOsm/kg, pH 7.34 and sodium is 154 mmol/L after correction. She is clinically very dehydrated. 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: A — Start cautious intravenous 0.9% sodium chloride with frequent osmolality monitoring

This is hyperosmolar hyperglycaemic state, where profound dehydration and hyperosmolality dominate and ketones are not significant. Initial treatment is cautious 0.9% sodium chloride with close monitoring of osmolality, sodium and fluid balance; insulin is often delayed or given at lower dose unless ketonaemia is present. Rapid insulin before adequate fluids can precipitate circulatory collapse and overly rapid osmotic shifts.

Reference: JBDS HHS Guideline 2023; BNF