Hyperosmolar hyperglycemic state Quiz: Ace Your Exams
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An 83-year-old man presents to the emergency department for evaluation of altered mental status. The patient's partner reports that they found him unresponsive that morning and reports the patient has been urinating constantly over the past two weeks and complaining of increased thirst and fatigue. The patient’s partner states that he has been non-adherent with his medications. The patient has a past medical history of peripheral vascular disease, atrial fibrillation, coronary artery disease, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Temperature is 36°C (96.8°F), blood pressure is 97/60 mmHg, pulse is 123/min, respiratory rate is 22/min, and oxygen saturation is 96% on room air. The patient appears ill and is unable to provide a clinical history. Physical examination demonstrates dry mucous membranes, poor skin turgor, and delayed capillary refill. Fingerstick blood glucose is >600 mg/dL and serum osmolality is 360 mOsm/kg. A serum arterial blood gas, complete metabolic panel, and urinalysis are pending. Which of the following additional diagnostic findings is most likely to be present?
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