BCCCP: Hyperglycemic Crisis Critical Care Questions

A 72-year-old man with a history of type 2 diabetes presents to the medical intensive care unit with lethargy and confusion. On exam, he is hypotensive (90/60 mmHg), tachycardic (110 bpm), afebrile, with dry mucous membranes and poor skin turgor. Initial laboratory evaluation shows: blood glucose 1150 mg/dL, serum osmolality 380 mOsm/kg, bicarbonate 22 mEq/L, pH 7.38, and small ketones in the urine. Which of the following pathophysiological processes is the primary driver of his current critical state?

A 52-year-old obese Hispanic man with a strong family history of type 2 diabetes presents with 2 days of polyuria, polydipsia, and altered mental status. Laboratory results show plasma glucose 680 mg/dL, serum bicarbonate 12 mEq/L, anion gap 22 mEq/L, and positive serum ketones. Which of the following best describes his diabetes subtype and its implications for long-term management?

A 28-year-old man with no known history of diabetes presents to the emergency department with a 3-week history of polyuria and polydipsia. He now has nausea, vomiting, and confusion. His family reports that he recently lost his job and health insurance, and he could not afford to see a doctor despite his symptoms. Laboratory evaluation confirms diabetic ketoacidosis. Which of the following is the most critical precipitating factor for his current hyperglycemic crisis?

A 68-year-old man with type 2 diabetes presents with altered mental status and hypotension. Laboratory studies reveal: serum glucose 1150 mg/dL, serum osmolality 360 mOsm/kg, arterial pH 7.38, bicarbonate 24 mEq/L, and negative urine ketones. Which statement most accurately describes his hyperglycemic crisis?

“A 45-year-old man with type 1 diabetes presents with altered mental status and a 2-day history of polyuria, polydipsia, and nausea. Laboratory results:
• Serum glucose: 480 mg/dL
• Sodium: 135 mEq/L
• Potassium: 4.0 mEq/L
• Chloride: 95 mEq/L
• Bicarbonate: 8 mEq/L
• BUN: 25 mg/dL
• Creatinine: 1.2 mg/dL
• Arterial blood gas: pH 6.95, pCO₂ 20 mmHg
• Urine ketones: Large

Based on these findings, which of the following is the most appropriate classification of this patient’s hyperglycemic crisis?”

“A 35-year-old man with known diabetes presents with polyuria, polydipsia, and progressive lethargy. On examination, he is somnolent but oriented to person and place. He appears dehydrated with dry mucous membranes, poor skin turgor, blood pressure 90/60 mm Hg, and heart rate 110 bpm. Laboratory studies reveal:
  • Blood glucose: 850 mg/dL
  • Serum sodium: 130 mEq/L
  • Arterial pH: 6.95
  • Serum bicarbonate: 8 mEq/L
  • Anion gap: 28 mEq/L
  • Serum osmolality: 330 mOsm/kg
  • Urine ketones: large

Based on these findings, which of the following best describes this patient’s hyperglycemic crisis?”

A 60-year-old man with poorly controlled type 2 diabetes presents with severe hyperglycemia. Laboratory results reveal a blood glucose of 850 mg/dL, serum bicarbonate 12 mEq/L, an anion gap of 22, a calculated serum osmolality of 345 mOsm/kg, and positive urine ketones. These findings indicate a mixed hyperglycemic crisis with overlapping features of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS). Which statement most accurately compares the mortality risks associated with the components of his hyperglycemic crisis?

A 35-year-old man with a history of type 1 diabetes mellitus is admitted to the critical care unit with altered mental status. He is intubated and on assist-control ventilation. A central venous catheter is in place for continuous infusions, including an insulin drip. Vital signs are: T 38.2 °C, heart rate 130 bpm, blood pressure 90/50 mmHg, SpO₂ 98% on FiO₂ 40%. Initial arterial blood gas shows pH 6.85, PaCO₂ 20 mmHg, HCO₃⁻ 5 mEq/L. Serum glucose is 750 mg/dL, serum ketones are strongly positive, and serum osmolality is 310 mOsm/kg. His serum potassium is 3.8 mEq/L, and phosphate is 1.2 mg/dL (normal 2.5–4.5 mg/dL). He is receiving aggressive isotonic crystalloid resuscitation and an insulin infusion. Given his current status, which of the following adjunctive therapies is most urgently indicated?

A 60-year-old woman with type 2 diabetes presents to the intensive care unit with lethargy and signs of severe dehydration after 3 days of polyuria, polydipsia, and omission of her insulin doses. On examination, her blood pressure is 85/55 mm Hg, heart rate 115 bpm, respiratory rate 22 breaths/min, temperature 37 °C, and mucous membranes are dry. She weighs 70 kg. Laboratory results are: glucose 850 mg/dL, sodium 148 mEq/L, potassium 4.0 mEq/L, bicarbonate 16 mEq/L, pH 7.28, anion gap 22, serum osmolality 345 mOsm/kg, and urine ketones trace. This presentation is consistent with a mixed hyperosmolar hyperglycemic state with mild ketoacidosis. Which of the following is the most appropriate initial management step?

Among patients admitted for hyperglycemic crisis, which clinical presentation is associated with the highest in-hospital mortality risk?