Which finding is NOT typical of Hyperosmolar Hyperglycemic State?

Which finding is NOT typical of Hyperosmolar Hyperglycemic State?

• A. Glucose > 600 mg/dL
• B. Serum osmolality > 320 mOsm/kg
• C. Ketones negative or only slightly elevated
• D. Fruity breath

Answer: (D)

Hyperosmolar Hyperglycemic State is defined by extreme hyperglycemia with profound dehydration and very high serum osmolality, but minimal or no ketosis. The hallmark features include glucose often well over 600 mg/dL and osmolality typically above 320 mOsm/kg, reflecting severe dehydration and the osmotic effects of glucose. Ketone production is suppressed enough by available insulin so ketones are negative or only faintly elevated, which is why there isn’t the significant acidosis seen in ketoacidosis. Fruity breath, however, comes from acetone produced during ketosis and is classic for diabetic ketoacidosis, not for HHS. So, fruity breath is the finding not typical of Hyperosmolar Hyperglycemic State.

Hyperosmolar Hyperglycemic State is defined by extreme hyperglycemia with profound dehydration and very high serum osmolality, but minimal or no ketosis. The hallmark features include glucose often well over 600 mg/dL and osmolality typically above 320 mOsm/kg, reflecting severe dehydration and the osmotic effects of glucose. Ketone production is suppressed enough by available insulin so ketones are negative or only faintly elevated, which is why there isn’t the significant acidosis seen in ketoacidosis. Fruity breath, however, comes from acetone produced during ketosis and is classic for diabetic ketoacidosis, not for HHS. So, fruity breath is the finding not typical of Hyperosmolar Hyperglycemic State.