How do DKA and HHS typically differ in patient population, ketone status, and acid-base profile?

• A. DKA usually in younger patients with positive ketones and anion gap metabolic acidosis; HHS in older type 2 patients with severe hyperglycemia and little to no ketones; both dehydration.
• B. HHS in younger patients with positive ketones; DKA in older; both dehydration.
• C. DKA never presents with dehydration; HHS always has ketones.
• D. Both always have high ketones and metabolic acidosis.

Answer: (A)

This item tests how DKA and HHS differ in who they affect, ketone presence, and acid-base status. In DKA, insulin deficiency sparks lipolysis and ketogenesis, so ketones are present and an anion gap metabolic acidosis develops. It typically shows up in younger patients, often with type 1 diabetes, though dehydration is common in both conditions due to osmotic diuresis.

In HHS, there’s enough insulin to largely prevent ketone production, so ketones are minimal or absent. Patients are usually older with type 2 diabetes, present with very high glucose and marked dehydration, and their acid-base status is near normal or only mildly acidotic, not a significant anion gap acidosis.

So the pattern described—DKA in younger patients with positive ketones and anion gap acidosis; HHS in older patients with little to no ketones and little to no acidosis—fits best. Dehydration can occur in both.