Comprehensive Diabetes and Thyroid Disorders: Pathophysiology, Symptoms, and Management Practice Test

In hyperosmolar hyperglycemic state, extreme hyperglycemia causes osmotic diuresis, leading to substantial loss of free water and a rapid drop in circulating volume. The strongest clue that dehydration is severe is profound dehydration paired with hypotension, which shows the intravascular volume depletion at its most severe.

Mild thirst with normal urine output doesn’t reflect significant fluid loss and can occur earlier or less markedly; weight gain implies fluid retention rather than loss, and low blood glucose contradicts the hyperglycemic picture of HHS.