Hyperosmolar hyperglycemic state Quiz: Ace Your Exams
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A 77-year-old man is brought by ambulance to the emergency department for evaluation of altered mental status. The patient resides in an assisted living facility and has been refusing his medications throughout the week due to feeling unwell, which was presumed to be due to an upper respiratory illness. The patient has a past medical history of coronary artery disease, type 2 diabetes mellitus, and hypertension. Temperature is 36°C (96.8°F), blood pressure is 85/60 mmHg, pulse is 122/min, respiratory rate is 22/min, and oxygen saturation is 95% on room air. The patient appears ill, is responsive only to pain, and is unable to provide a clinical history. Fingerstick blood glucose is >600 mg/dL (<120 mg/dL) and venous pH is 7.42. (7.35-7.45) Serum osmolality is 390 mOsm/kg (275-295 mOsm/kg). Which of the following additional features is most likely to be present?
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