RN Nursing · Health Assessment · Practice question
What is a manifestation of hyperosmolar hyperglycemia syndrome (HHS)?
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Hypothermia.
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Reduced urine output.
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✓
Extreme thirst
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Ketonuria.
Answer & explanation
Correct: Extreme thirst
Hyperosmolar hyperglycemia syndrome (HHS) is a serious complication of type 2 diabetes characterized by severely elevated blood glucose levels, profound dehydration, and hyperosmolarity without significant ketoacidosis. Extreme thirst, or polydipsia, is a hallmark manifestation because the massively elevated serum glucose draws water out of cells through osmosis, triggering the thirst response and causing severe cellular dehydration. The body attempts to eliminate excess glucose through osmotic diuresis, which actually results in increased, not reduced, urine output, making reduced urine output incorrect. Hypothermia is not associated with HHS; rather, fever may be present due to dehydration or underlying infection that precipitated the crisis. Ketonuria is characteristic of diabetic ketoacidosis (DKA), not HHS. In HHS, there is sufficient residual insulin activity to suppress lipolysis and ketone body formation, so significant ketonemia and ketonuria are absent. This distinction is clinically important because it differentiates HHS from DKA. Other manifestations of HHS include altered mental status, extreme hyperglycemia often exceeding 600 mg/dL, elevated serum osmolarity typically above 320 mOsm/kg, and neurological deficits. Recognizing extreme thirst as a key early symptom can help prompt early intervention before the condition becomes life-threatening.
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