👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-07-11🏷️ Physiological Adaptation🔖 Free to read, print, and share
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Use this quick-reference guide to spot, treat, and prevent Hyperosmolar Hyperglycemic State (HHS) on the NCLEX. Keep it handy during review and on exam day!
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Mechanism
Key facts
Type 2 DM, severe hyperglycemia
Enough insulin to block ketones
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Labs
Key numbers
Glucose >600 mg/dL (often >1000)
↑ osmolality, NO/minimal ketones
pH normal, no Kussmaul
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Signs
What to look for
Severe dehydration, ↑ thirst
Altered LOC, seizures, coma
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Do
Nursing actions
IV NS fluids FIRST priority
Insulin drip, replace K+
Monitor K+ as glucose ↓
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Quick Tip
Blood glucose is extremely high (often greater than 600 mg/dL) with very high serum osmolality.