A nurse is preparing to receive a client from the emergency department who is being treated for a blood glucose of 750 mg/dL. Which of the following laboratory findings would support the provider’s diagnosis of hyperglycemic hyperosmolar state (HHS)? (Select all that apply)

Choice A reason: HCO3 23 mEq/L (normal 21-28 mEq/L) is within normal range but not specific to HHS. HHS typically has normal or slightly reduced HCO3 due to minimal acidosis, but this finding alone does not strongly support HHS diagnosis compared to elevated osmolarity or normal pH. Choice B reason: Positive ketones in urine are more typical of DKA, not HHS. HHS involves severe hyperglycemia with minimal ketosis due to sufficient insulin to prevent ketogenesis. Positive ketones suggest DKA’s metabolic profile, making this finding inconsistent with an HHS diagnosis. Choice C reason: pH 7.43 (normal 7.35-7.45) supports an HHS diagnosis, as HHS typically presents with normal or near-normal pH due to minimal ketone production compared to DKA’s acidosis. This reflects HHS’s primary issue of hyperglycemia and hyperosmolarity, making it a key finding. Choice D reason: Serum osmolarity 330 mOsm/L (normal 270-300 mOsm/L) is a hallmark of HHS, driven by severe hyperglycemia (e.g., 750 mg/dL) causing osmotic shifts and dehydration. Elevated osmolarity distinguishes HHS from DKA, supporting the diagnosis and guiding fluid therapy. Choice E reason: pH 7.23 indicates significant acidosis, typical of DKA, not HHS. HHS has minimal ketosis, resulting in normal or slightly acidotic pH. This low pH is inconsistent with HHS’s metabolic profile, making it an incorrect finding for supporting the diagnosis.