Which condition is associated with severe dehydration and high blood glucose with no significant ketosis?

• A. Lactic acidosis
• B. Hyperosmolar hyperglycemic state
• C. Diabetic ketoacidosis
• D. Hypoglycemia

Answer: (B)

The key idea is that extremely high blood glucose with severe dehydration but little or no ketosis points to a hyperosmolar state driven by osmotic diuresis. In a hyperosmolar hyperglycemic state, very high glucose levels pull water into the urine, causing rapid and profound dehydration. Because there’s still some insulin activity, lipolysis and ketogenesis are suppressed, so ketosis is minimal or absent despite the high glucose.

In contrast, diabetic ketoacidosis features marked ketosis and metabolic acidosis due to abundant ketone production, even if glucose is high. Lactic acidosis centers on elevated lactate and acidosis, not primarily on ketosis from hyperglycemia. Hypoglycemia, by definition, involves low blood glucose, not high.

So the presentation described—severe dehydration with very high glucose and no significant ketosis—fits hyperosmolar hyperglycemic state.