A nurse is caring for a client in the emergency department. Exhibits For each assessment finding, click to specify if the assessment finding is consistent with diabetic ketoacidosis (DKA) or hyperglycemic-hyperosmolar state (HHS). Each finding may support more than 1 disease process.

Rationale: Skin turgor: In DKA, dehydration is a common result due to fluid loss from excessive urination and hyperglycemia. Decreased skin turgor, or slight tenting, is an indicator of dehydration. HHS is characterized by severe hyperglycemia and profound dehydration, leading to significant fluid deficits and impaired skin turgor. Blood glucose greater than expected reference range: Both DKA and HHS present with elevated blood glucose levels. The client's blood glucose level of 468 mg/dL is higher than the expected range. However, blood glucose levels tend to be much higher in HHS, sometimes exceeding 1000 mg/dL, while DKA usually ranges between 250–600 mg/dL. Blood pH: A blood pH of 7.30 is low and indicative of acidosis, which is a hallmark of DKA. In DKA, the body produces ketones as a byproduct of fat metabolism, which causes the blood pH to drop, leading to metabolic acidosis. HHS typically does not cause significant acidosis, and pH is generally within normal limits. Creatinine greater than expected reference range: Elevated creatinine levels suggest kidney impairment, which is common in DKA and HHS due to severe dehydration and osmotic diuresis. Dehydration significantly impairs renal perfusion and function, leading to elevated creatinine and BUN levels. Urine ketones: Ketones form when the body starts breaking down fat for energy due to a lack of insulin, which is characteristic of DKA. In HHS, the body does not typically produce significant amounts of ketones, as some insulin is still present and inhibiting fat metabolism.