Which feature distinguishes HHS from DKA?

Which feature distinguishes HHS from DKA?

• A. Absence of significant ketosis.
• B. Profound metabolic acidosis.
• C. Low glucose levels.
• D. Hyperkalemia is the defining feature.

Answer: (A)

Ketone production and acid-base status distinguish HHS from DKA. In hyperosmolar hyperglycemic state there is enough endogenous insulin to suppress lipolysis and ketogenesis, so significant ketosis does not develop. The result is severe hyperglycemia with dehydration and high serum osmolality but little or no metabolic acidosis. In contrast, diabetic ketoacidosis involves insufficient insulin, triggering lipolysis and production of ketoacids, leading to significant ketosis and a high anion gap metabolic acidosis. Therefore, absence of significant ketosis best differentiates HHS from DKA. The other options reflect features more typical of DKA (profound metabolic acidosis) or are not distinguishing (low glucose is not characteristic of HHS; hyperkalemia can occur in both and is not defining).

Ketone production and acid-base status distinguish HHS from DKA. In hyperosmolar hyperglycemic state there is enough endogenous insulin to suppress lipolysis and ketogenesis, so significant ketosis does not develop. The result is severe hyperglycemia with dehydration and high serum osmolality but little or no metabolic acidosis. In contrast, diabetic ketoacidosis involves insufficient insulin, triggering lipolysis and production of ketoacids, leading to significant ketosis and a high anion gap metabolic acidosis. Therefore, absence of significant ketosis best differentiates HHS from DKA. The other options reflect features more typical of DKA (profound metabolic acidosis) or are not distinguishing (low glucose is not characteristic of HHS; hyperkalemia can occur in both and is not defining).