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.

Urine ketones: The client’s urine is positive for ketones, which is a hallmark of DKA caused by insulin deficiency leading to fat breakdown and ketone production. Ketones are usually absent in HHS because some insulin is present, preventing significant ketogenesis. Blood pH: The client’s pH is 7.30, indicating metabolic acidosis, which is characteristic of DKA due to accumulation of ketoacids. In HHS, pH is usually normal or only slightly decreased. Skin turgor: The client has slight tenting, indicating dehydration. Dehydration is present in both DKA and HHS due to osmotic diuresis from hyperglycemia, making this finding consistent with both conditions. Blood glucose greater than expected reference range: Hyperglycemia occurs in both conditions. In DKA, glucose is often elevated (typically 250–600 mg/dL), and in HHS, it is usually more extreme (>600 mg/dL). The client’s glucose of 468 mg/dL is consistent with both DKA and early/mild HHS. Creatinine greater than expected reference range: Creatinine is elevated (1.7 mg/dL), indicating possible dehydration or prerenal acute kidney injury. This can occur in both DKA and HHS as a result of fluid loss and reduced renal perfusion.