Which of the following is not a typical feature of HHNS?

• A. Ketones in urine
• B. Severe dehydration
• C. Hypernatremia
• D. Very high glucose levels

Answer: (A)

In HHNS the main pattern is very high blood glucose with profound dehydration and high serum osmolality, but little or no ketosis. This happens because there is usually enough insulin to prevent lipolysis and ketone production, even though it isn’t sufficient to normalize glucose. So ketones in urine are not a typical feature of HHNS; their presence would suggest diabetic ketoacidosis or a mixed picture. The other features—severe dehydration from osmotic diuresis, hypernatremia from water loss, and very high glucose levels—are classic for HHNS. If ketones are detected, consider a possible overlap with DKA or an atypical presentation, but they don’t define HHNS.