Which laboratory pattern is typically seen in Hyperosmolar Hyperglycemic State (HHS)?

Which laboratory pattern is typically seen in Hyperosmolar Hyperglycemic State (HHS)?

• A. Glucose >600; increased serum osmolality (>315); negative ketones
• B. Glucose >600; decreased osmolality; positive ketones
• C. Glucose >600; increased osmolality; negative ketones
• D. Glucose >900; normal osmolality; positive ketones

Answer: (C)

Hyperosmolar Hyperglycemic State shows a pattern of extreme hyperglycemia with significant dehydration leading to high serum osmolality, but little or no ketosis. The insulin level is enough to suppress lipolysis, so ketone production is minimal, which is why ketones are negative. That combination—glucose often over 600 mg/dL, elevated osmolality (commonly >315 mOsm/kg), and negative ketones—is the hallmark that distinguishes HHS from other hyperglycemic crises like diabetic ketoacidosis, where ketones are present and acidosis occurs.

Hyperosmolar Hyperglycemic State shows a pattern of extreme hyperglycemia with significant dehydration leading to high serum osmolality, but little or no ketosis. The insulin level is enough to suppress lipolysis, so ketone production is minimal, which is why ketones are negative. That combination—glucose often over 600 mg/dL, elevated osmolality (commonly >315 mOsm/kg), and negative ketones—is the hallmark that distinguishes HHS from other hyperglycemic crises like diabetic ketoacidosis, where ketones are present and acidosis occurs.