Rosh Emergency Medicine Practice Test

In diabetic ketoacidosis, which clinical finding is more common compared to hyperosmolar hyperglycemic state?

1. Abdominal pain

2. Focal neurologic deficits

3. Obtundation

4. Polyuria

The correct answer is: Abdominal pain

In diabetic ketoacidosis (DKA), abdominal pain is a common clinical finding, often resulting from the metabolic disturbances associated with the condition. The presence of ketosis leads to increased production of ketone bodies, which can irritate the gastrointestinal (GI) tract and result in abdominal discomfort or pain. This symptom is particularly prevalent in DKA compared to hyperosmolar hyperglycemic state (HHS), where abdominal pain is less frequently reported. In HHS, while patients can exhibit altered consciousness and may experience hyperglycemia-related complications, abdominal pain is not as prominently featured. Instead, HHS typically presents with severe dehydration, osmotic diuresis, and potentially altered mental status without the same level of GI symptoms experienced in DKA. Other findings in DKA, such as obtundation and polyuria, can occur in both DKA and HHS, however, the characteristic and acute nature of abdominal pain in DKA distinguishes it from HHS, making it a more common clinical finding in this scenario.