What distinguishes hyperglycemic hyperosmolar state (HHS)?

What distinguishes hyperglycemic hyperosmolar state (HHS)?

• A. Ketone formation is present.
• B. It is a hyperglycemic crisis without ketone formation, most serious in Type II DM, typically in patients over 50.
• C. It occurs primarily in Type I DM younger.
• D. It features metabolic acidosis.

Answer: (B)

Hyperglycemic hyperosmolar state is defined by extreme hyperglycemia with marked dehydration and a very high serum osmolality, but with little to no ketone production and no significant metabolic acidosis. The presence of insulin is enough to suppress lipolysis and ketogenesis, yet not enough to prevent severe hyperglycemia in the setting of insulin resistance and reduced fluid intake. This combination is most typical in older adults with type 2 diabetes, usually over 50, and is often precipitated by illness, poor fluid intake, or dehydration. That absence of ketones and acidosis, along with the patient’s age and diabetes type, is what sets HHS apart from other diabetic crises.

Hyperglycemic hyperosmolar state is defined by extreme hyperglycemia with marked dehydration and a very high serum osmolality, but with little to no ketone production and no significant metabolic acidosis. The presence of insulin is enough to suppress lipolysis and ketogenesis, yet not enough to prevent severe hyperglycemia in the setting of insulin resistance and reduced fluid intake. This combination is most typical in older adults with type 2 diabetes, usually over 50, and is often precipitated by illness, poor fluid intake, or dehydration. That absence of ketones and acidosis, along with the patient’s age and diabetes type, is what sets HHS apart from other diabetic crises.