Hyperosmolar hyperglycemic syndrome: The Daily PANCE Blueprint

The answer is B. Adults with Type 2 diabetes

Hyperosmolar Hyperglycemic Syndrome (HHS) most commonly occurs in older adults with poorly controlled Type 2 diabetes, especially in the setting of acute illness or infection. Unlike diabetic ketoacidosis (DKA), HHS is characterized by severe hyperglycemia, hyperosmolarity, profound dehydration, and an absence of significant ketosis, due to the presence of some circulating insulin that suppresses lipolysis and ketogenesis. Precipitating factors such as infection, stroke, or medication noncompliance are common triggers. Treatment involves aggressive fluid resuscitation with isotonic saline, correction of electrolyte imbalances (especially potassium), and intravenous insulin therapy. Careful monitoring is essential to avoid complications such as cerebral edema or hypokalemia.

Incorrect answer explanations:

• A. Pediatric patients with Type 1 diabetes – These patients are more likely to develop DKA, not HHS, due to absolute insulin deficiency leading to ketoacidosis.
• C. Pregnant women with gestational diabetes – Although hyperglycemia is a concern in this group, HHS is rare in gestational diabetes and typically does not occur without pre-existing diabetes.
• D. Adolescents with recent onset of Type 1 diabetes – Like younger children, adolescents with Type 1 diabetes are more prone to DKA because of complete insulin deficiency.
• E. Middle-aged adults without a history of diabetes – While HHS can be a first presentation of diabetes, it is uncommon in individuals with no prior diagnosis or risk factors for Type 2 diabetes.