Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

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What is the first treatment priority for a person experiencing Hyperosmolar Hyperglycemic State (HHS)?

Decrease blood glucose by infusing insulin
Rehydrate by providing adequate IV fluids
Correct electrolyte imbalances
Address underlying infections

The correct answer is: Rehydrate by providing adequate IV fluids

In the case of Hyperosmolar Hyperglycemic State (HHS), the primary treatment priority is to rehydrate the patient by providing adequate intravenous (IV) fluids. HHS is characterized by extremely high blood glucose levels, which lead to significant dehydration and hyperosmolality due to osmotic diuresis. This excessive fluid loss can result in severe complications, including impaired kidney function and altered mental status. Administering IV fluids helps restore proper fluid balance and improve circulation, which is critical in stabilizing the patient’s condition. Once the patient is adequately rehydrated, the focus can shift to lowering blood glucose levels and addressing electrolyte abnormalities, but without addressing dehydration first, these other interventions may have limited effectiveness. Rehydration not only aids in correcting the hyperosmolar state but also improves intravascular volume and kidney perfusion, which is essential for renal function and the excretion of excess glucose. Therefore, ensuring that rehydration is the first step in treatment is essential in managing HHS effectively.