Which of the following clinical manifestations is most indicative of HHS rather than DKA in a patient with diabetes?

Rationale: A. Hyperosmolar hyperglycemic state (HHS) is characterized by very high blood glucose levels, often exceeding 600 mg/dL, and severe dehydration due to osmotic diuresis. Unlike DKA, HHS typically has minimal or no ketosis and a near-normal pH, making extreme hyperglycemia and dehydration the hallmark indicators. B. Kussmaul respirations (deep, rapid breathing) occur in response to metabolic acidosis, which is a classic feature of diabetic ketoacidosis (DKA), not HHS. HHS usually does not produce significant acidosis. C. Significant ketonuria is a defining feature of DKA, not HHS. In HHS, ketone production is minimal or absent because insulin levels, while insufficient for normal glucose utilization, are typically enough to suppress ketogenesis. D. HHS patients usually maintain a near-normal blood pH (7.35–7.45). Severe acidosis with low pH is a hallmark of DKA, making this finding more indicative of DKA rather than HHS