What are the signs and symptoms of HHS?

• A. Hyperactive reflexes and tremor.
• B. Rash and itching.
• C. Hypoglycemia and weight gain.
• D. Hypotension, profound dehydration, tachycardia, neuro signs (e.g., decreased LOC, seizures), and elevated serum glucose levels.

Answer: (D)

Hyperosmolar hyperglycemic state presents with severe hyperglycemia, profound dehydration, and high serum osmolality that leads to brain dysfunction. The signs described—low blood pressure with apparent volume loss, a fast heartbeat from tachycardia, and significant dehydration—reflect substantial fluid loss from osmotic diuresis. The neuro signs, such as decreased level of consciousness or seizures, occur because the hyperosmolar state impairs brain function. The defining lab feature is the very high glucose level, often with little or no ketosis, contributing to the osmotic pull that drives water out of cells and into the bloodstream.

Other options don’t fit this picture. Hyperactive reflexes and tremor are not typical of HHS and point more toward conditions like hypoglycemia or thyroid/stimulant disturbances. Rash and itching are irrelevant to this metabolic emergency. Hypoglycemia with weight gain would not describe HHS, which involves high glucose and typically weight loss from dehydration.