Florida State Paramedic Practice Exam

If a patient shows DKA symptoms but lacks Kussmaul's respirations and fruity odor, what might they have?

1. Hypoglycemia

2. HHNK syndrome

3. Cardiac arrest

4. Chronic kidney disease

The correct answer is: HHNK syndrome

In cases where a patient exhibits symptoms consistent with diabetic ketoacidosis (DKA) but lacks Kussmaul respirations and a fruity odor, it raises the possibility of hyperglycemic hyperosmolar nonketotic (HHNK) syndrome. This condition is often seen in patients with type 2 diabetes and is characterized by a significantly high glucose level but typically does not present with the characteristic metabolic acidosis seen in DKA. The absence of Kussmaul respirations, which are deep and labored breathing patterns often a compensatory response to acidosis, suggests that the patient may not be in a state of metabolic acidosis. Similarly, the lack of a fruity odor, which is due to acetone presence in the breath that typically accompanies DKA, indicates that ketone production might not be occurring at a significant level. HHNK syndrome is primarily characterized by severe hyperglycemia, high plasma osmolality, and dehydration without significant ketoacidosis, making it a plausible condition for patients who closely resemble those with DKA but differ by the absence of certain classic symptoms. Recognizing this distinction is crucial for ensuring appropriate and timely management of the patient's hyperglycemic state.