What distinguishes Hyperosmolar Hyperglycemic Syndrome (HHS) from DKA?

• A. HHS only occurs in type 1 diabetes.
• B. HHS typically occurs in diabetes mellitus type 2, does not lead to ketosis or metabolic acidosis, and has a slower onset.
• C. HHS involves rapid onset ketosis and acidosis.
• D. HHS is essentially the same as DKA.

Answer: (B)

The key idea is how HHS and DKA differ in insulin impact, ketosis, acid-base status, and how quickly they develop. In HHS, most patients have type 2 diabetes and retain enough insulin to prevent significant lipolysis, so ketosis and metabolic acidosis are minimal or absent. The result is a very high blood glucose level that drives extreme dehydration through osmotic diuresis, leading to high serum osmolality. Because the insulin level isn’t utterly absent, there isn’t the acid-base catastrophe seen in DKA. The onset tends to be gradual, developing over days to weeks rather than hours.

That’s why the description stating that HHS typically occurs in type 2 diabetes, does not lead to ketosis or metabolic acidosis, and has a slower onset is the best fit. The other statements either imply ketosis and acidosis are prominent, or claim HHS is the same as DKA, or limit it to type 1, which doesn’t align with the typical clinical picture.