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Hard"B"HHS requires marked hyperglycaemia and hyperosmolality with minimal ketosis and no significant acidosis (pH >=7.3, HCO3- >=15). This profile matches HHS. DKA features are absent; euglycaemic DKA has lower glucose; starvation ketosis has low glucose."ada consensus report (2024): hyperglycaemic crises in adults with diabetes"

A 78-year-old with severe hyperglycaemia and confusion has plasma glucose 740 mg/dL

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