Which statement accurately describes a key difference between HHNS and DKA?

Which statement accurately describes a key difference between HHNS and DKA?

• A. DKA occurs with ketosis; HHNS does not.
• B. DKA is ketosis with acidosis; HHNS has high osmolarity with minimal ketosis.
• C. DKA presents with fruity breath; HHNS does not.
• D. HHNS occurs only in type 1 diabetes; DKA occurs only in type 2.

Answer: (B)

The main idea is how these two hyperglycemic emergencies differ in metabolic state. In diabetic ketoacidosis, a severe insulin deficiency drives lipolysis and hepatic ketogenesis, so ketone bodies accumulate and the blood becomes acidotic. In hyperosmolar hyperglycemic state, there’s usually enough insulin to largely suppress ketone production, so there’s minimal ketosis and no significant acidosis, but extreme hyperglycemia causes profound dehydration and a very high serum osmolarity. That’s why the best description is that DKA is ketosis with acidosis, while HHNS features high osmolarity with minimal ketosis. The other statements aren’t as accurate: ketosis can be present at least to some degree in HHNS, DKA can occur in type 2 diabetes under stress, and fruity breath is not a reliable distinguishing feature.

The main idea is how these two hyperglycemic emergencies differ in metabolic state. In diabetic ketoacidosis, a severe insulin deficiency drives lipolysis and hepatic ketogenesis, so ketone bodies accumulate and the blood becomes acidotic. In hyperosmolar hyperglycemic state, there’s usually enough insulin to largely suppress ketone production, so there’s minimal ketosis and no significant acidosis, but extreme hyperglycemia causes profound dehydration and a very high serum osmolarity. That’s why the best description is that DKA is ketosis with acidosis, while HHNS features high osmolarity with minimal ketosis. The other statements aren’t as accurate: ketosis can be present at least to some degree in HHNS, DKA can occur in type 2 diabetes under stress, and fruity breath is not a reliable distinguishing feature.