What laboratory findings are typical of hyperosmolar hyperglycemic state?

• A. Severe hyperglycemia (>600 mg/dL), high serum osmolality, dehydration, little or no ketones
• B. Hypoglycemia with ketosis
• C. Moderate hyperglycemia with significant ketones
• D. Low osmolality with dehydration

Answer: (A)

Hyperosmolar hyperglycemic state shows extreme hyperglycemia with high serum osmolality and marked dehydration, but little or no ketones. The labs reflect this: glucose often exceeds 600 mg/dL, serum osmolality is elevated (often well above normal), and there is significant dehydration from osmotic diuresis. Because there’s enough insulin to suppress lipolysis, ketone production is minimal, so there isn’t a substantial metabolic acidosis. This pattern distinguishes HHS from conditions with ketosis or acidosis, such as diabetic ketoacidosis, and from scenarios with low osmolality.