A 55-year-old patient is diagnosed with Meniere’s disease. Which of the following symptoms is most characteristic of this condition?

Choice A Reason:

Acetone breath is typically associated with diabetic ketoacidosis (DKA), not hyperosmolar hyperglycemic syndrome (HHS). DKA occurs when there is a significant production of ketones due to the breakdown of fat for energy, leading to a fruity or acetone-like smell on the breath. HHS, on the other hand, does not usually involve significant ketone production.

Choice B Reason:

Fever can be a manifestation of HHS, especially if there is an underlying infection or illness that has precipitated the hyperglycemic crisis. Infections are common triggers for HHS and can contribute to the severity of the condition.

Choice C Reason:

Older age is a risk factor for HHS. HHS is more commonly seen in older adults with type 2 diabetes, often those who have underlying chronic conditions or are experiencing acute illness. The patient’s age of 68 years supports the likelihood of HHS.

Choice D Reason:

A serum glucose level of 800 mg/dL is indicative of HHS. HHS is characterized by extremely high blood glucose levels, often exceeding 600 mg/dL, without significant ketone production. This high glucose level leads to severe dehydration and hyperosmolarity.

Choice E Reason:

A serum bicarbonate level of 15 mEq/L is more indicative of DKA rather than HHS. In HHS, serum bicarbonate levels are typically normal or only mildly decreased because there is no significant ketoacidosis. Therefore, this choice does not support the clinical presentation of HHS.

Choice F Reason:

An insidious onset is characteristic of HHS. Unlike DKA, which can develop rapidly, HHS often develops over days to weeks. Patients may experience gradually worsening symptoms such as increased thirst, frequent urination, and confusion before seeking medical attention.

Choice A Reason:

Diabetes Insipidus (DI) is characterized by excessive urination and thirst due to a deficiency of antidiuretic hormone (ADH) or a renal insensitivity to ADH. Patients with DI typically present with hypernatremia (high serum sodium) and low urine osmolality, which contrasts with the findings of low serum sodium and high urine osmolality in this patient.

Choice B Reason:

Adrenal insufficiency can cause hyponatremia and hyperkalemia due to a deficiency in aldosterone and cortisol. However, it usually presents with low serum osmolality and low urine sodium, which does not align with the patient’s laboratory results of high urine osmolality and elevated urine sodium.

Choice C Reason:

Hyperaldosteronism leads to increased sodium reabsorption and potassium excretion, resulting in hypernatremia and hypokalemia. This condition does not match the patient’s findings of hyponatremia and high urine osmolality.

Choice D Reason:

Syndrome of inappropriate Antidiuretic Hormone (SIADH) is characterized by excessive release of ADH, leading to water retention, hyponatremia, and concentrated urine. The patient’s laboratory results of low serum sodium, low serum osmolality, high urine osmolality, and elevated urine sodium are consistent with SIADH. This condition causes the kidneys to reabsorb water, diluting the blood and concentrating the urine.