Hyperosmolar hyperglycemic state commonly presents in which patient population?

• A. Commonly occurs in older adults with type 2 diabetes and dehydration with little ketosis
• B. Occurs with significant ketosis
• C. Always accompanied by severe acidosis
• D. Is primarily seen in type 1 diabetes

Answer: (A)

Hyperosmolar hyperglycemic state develops when extremely high blood glucose causes osmotic diuresis, leading to profound dehydration. Because there is still some insulin activity, lipolysis and ketogenesis are limited, so ketosis and acidosis are minimal. This pattern is most typical in older adults with type 2 diabetes who encounter a precipitating factor such as infection or poor fluid intake. The hallmark features are very high glucose, high serum osmolality, dehydration, and altered mental status, rather than significant ketosis or severe acidosis. Therefore, it fits older adults with type 2 diabetes and dehydration with little ketosis. It is not primarily seen in type 1 diabetes, and it does not involve substantial ketosis or significant acidosis.