Which of the following are key differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)? (Select all that apply).
Blood glucose levels in DKA are typically higher than in HHS
DKA involves significant ketosis and metabolic acidosis, while HHS typically does not
DKA is more common in type 1 diabetes, while HHS is more common in type 2 diabetes
None of the above
HHS patients often have more severe dehydration than DKA patients
Correct Answer : A,B,C,E
A. Blood glucose levels in DKA are typically higher than in HHS: In fact, HHS usually presents with higher blood glucose levels than DKA—often exceeding 600 mg/dL, while DKA typically ranges from 250 to 600 mg/dL.
B. DKA involves significant ketosis and metabolic acidosis, while HHS typically does not: DKA is characterized by the breakdown of fats into ketones, leading to metabolic acidosis. HHS typically lacks significant ketosis because insulin levels, while low, are still sufficient to suppress ketogenesis.
C. DKA is more common in type 1 diabetes, while HHS is more common in type 2 diabetes: DKA usually occurs in individuals with type 1 diabetes due to absolute insulin deficiency. HHS is more often seen in type 2 diabetics who still produce some insulin but not enough to prevent severe hyperglycemia and dehydration.
D. None of the above: This choice is incorrect, as B, C, and E are valid differences between DKA and HHS.
E. HHS patients often have more severe dehydration than DKA patients: HHS leads to profound osmotic diuresis over a longer period, causing extreme dehydration. DKA progresses faster but with less total fluid loss compared to HHS.
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Correct Answer is C
Explanation
A. Androgens (sex hormones): These are produced in the zona reticularis of the adrenal cortex. They contribute to the development of secondary sex characteristics and have a minor role compared to gonadal hormones.
B. Glucocorticoids (cortisol): Cortisol is synthesized in the zona fasciculata of the adrenal cortex. It regulates metabolism, immune responses, and the stress response, making it a key adrenal cortical hormone.
C. Epinephrine: This hormone is produced by the adrenal medulla, not the cortex. It plays a major role in the fight-or-flight response, increasing heart rate and blood glucose levels during stress.
D. Mineralocorticoids (aldosterone): Aldosterone is produced in the zona glomerulosa of the adrenal cortex. It is essential for sodium retention, potassium excretion, and blood pressure regulation.
Correct Answer is A
Explanation
A. Urine output <30mL/hour: Oliguria is defined as a markedly reduced urine output, typically less than 400 mL per day or less than 30 mL per hour. It indicates decreased kidney function or perfusion and is common in progressive renal conditions.
B. Absence of urine output: This describes anuria, not oliguria. Anuria is defined as urine output less than 100 mL per day and signifies severe kidney failure or complete urinary tract obstruction.
C. Increased urine output: This describes polyuria, often associated with conditions like uncontrolled diabetes mellitus or diabetes insipidus, not oliguria.
D. Urine output >100mL/hour: This is well above the threshold for oliguria and may suggest diuresis or overhydration. It does not meet the criteria for decreased kidney output.
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