Archive Of Standardized Exam Questions: Hyperglycemic Hyperosmotic State (HHS)


This page is dedicated to organizing various examples of standardized exam questions whose answer is hyperglycemic hyperosmotic state. While this may seem a odd practice, it is useful to see multiple examples of how hyperglycemic hyperosmotic state will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.


Question # 1

An 84 year old man is brought to the emergency department after being found unresponsive in his condo by a neighbor. His past medical history is notable for type 2 diabetes that is not controlled with medication (but by diet alone). Upon arrival the patient is obtunded, temperature is 100.4°F, pulse is 120/min, respirations are 24/min. and blood pressure is 95/55 mm Hg. A physical exam is notable for dry mucous membranes and poor skin turgor. No jugular venous distention is appreciated. The rest of the physical exam is non-contributory. Laboratory studies are collected and shown below:

  • Hematocrit: 48%
  • Leukocyte count: 15.000/mm³
  • Neutrophils: 70%
  • Bands: 18%
  • Lymphocytes: 11%
  • Monocytes: 1%
  • Platelet count: 250,000/mm³
  • Na+: 138 mEq/L
  • Cl-: 95 mEq/L
  • K+: 4.1 mEq/L
  • HCO3-: 27 mEq/L
  • Urea nitrogen: 65 mg/dL
  • Glucose: 850 mg/dL***
  • Creatinine: 2.3 mg/dL

What is the likely diagnosis in this patient?

Explanation: obtunded patient + type 2 diabetic (poorly controlled) + high serum glucose = hyperglycemic hyperosmotic state

Page Updated: 12.25.2016