What is the significant difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHNS)?

• A. DKA occurs with ketosis and acidosis; HHNS involves ketosis.
• B. DKA presents with normal osmolarity; HHNS presents with high osmolarity.
• C. DKA is primarily a condition of older adults; HHNS occurs in youths.
• D. DKA features ketosis and acidosis; HHNS features marked dehydration with very high glucose and minimal ketosis.

Answer: (D)

The key distinction is about ketosis and acidosis. In DKA, there is a lack of insulin enough to prevent lipolysis and ketone production, so ketones build up and you get metabolic acidosis with an elevated anion gap. In HHNS, there’s enough insulin to largely stop ketogenesis, so ketosis is minimal or absent, but glucose runs very high and osmotic diuresis causes severe dehydration with high serum osmolarity. So the important difference is ketosis with acidosis in DKA versus marked dehydration with very high glucose and little to no ketosis in HHNS.