How does hyperosmolar hyperglycemic state (HHS) typically present?

• A. Hyperglycemia with significant ketosis
• B. Hypoglycemia with ketosis
• C. Severe hyperglycemia with dehydration and little or no ketosis
• D. Hypotension with jaundice

Answer: (C)

Hyperosmolar hyperglycemic state presents with extreme high blood glucose causing profound dehydration from osmotic diuresis, and crucially, little or no ketosis because there is enough insulin to prevent significant lipolysis and ketogenesis. The result is severe hyperglycemia with high serum osmolality and dehydration, often leading to altered mental status or confusion and possible hypotension from volume depletion. This combination distinguishes HHS from conditions with ketosis and acidosis, such as diabetic ketoacidosis, and from hypoglycemia, which is not characteristic of HHS. Jaundice isn’t a typical feature of HHS and suggests other liver-related issues, making that option less fitting.