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Hyperosmolar hyperglycemic state — RCPSC IM MCQ

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HardEndocrinologyHyperosmolar hyperglycemic stateRCPSC IM

A 78-year-old woman with type 2 diabetes is brought in confused after a week of poor intake. Glucose is 48 mmol/L, measured osmolality is 348 mOsm/kg, pH is 7.34, bicarbonate is 20 mmol/L and ketones are trace. Sodium corrected for glucose is 152 mmol/L and creatinine is 240 micromol/L. What is the most appropriate management?

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

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Correct answer: D — Careful intravenous fluid replacement followed by low-dose insulin once volume is being restored

HHS is dominated by severe dehydration and hyperosmolality. Gradual fluid restoration is the priority, with cautious insulin after initial volume resuscitation.

Reference: Diabetes Canada clinical practice guidelines