A nurse is caring for a client in the emergency department. 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.

• Blood glucose greater than expected reference range: Both DKA and HHS present with significant hyperglycemia. In DKA, glucose is typically moderately elevated (250–600 mg/dL), while HHS usually shows extreme hyperglycemia (>600 mg/dL). Hyperglycemia is a hallmark finding in both conditions, driving osmotic diuresis and dehydration. • Skin turgor: Dehydration from osmotic diuresis is common in both DKA and HHS, resulting in poor skin turgor. Fluid loss occurs due to polyuria and inadequate intake, contributing to hypotension, tachycardia, and electrolyte imbalances in both conditions. • Urine ketones: Urine ketones are characteristic of DKA due to lipolysis and ketogenesis caused by insulin deficiency. HHS typically has minimal to absent ketone production because some insulin is present, preventing significant fat breakdown. • Creatinine greater than expected reference range: Elevated creatinine occurs in both DKA and HHS due to dehydration and pre-renal azotemia from hypovolemia. This reflects impaired renal perfusion and is a marker for severity of fluid deficit in both conditions. • Blood pH: Metabolic acidosis (low pH) is a defining feature of DKA due to accumulation of ketoacids. HHS usually maintains a near-normal pH because ketosis is minimal, so acidosis is typically absent or mild.