Pathophysiology
Clinical meaning
DKA: Absolute insulin deficiency leads to lipolysis. Free fatty acids are oxidized to ketone bodies (beta-hydroxybutyrate), causing metabolic acidosis. HHS: Relative insulin deficiency prevents ketosis but severe hyperglycemia causes massive osmotic diuresis and hyperosmolar state. Connect DKA/HHS: Anion Gap & Osmolality to bedside cues you will reassess first: vitals trends, work of breathing, perfusion, mentation, and pain or ischemic equivalents when relevant. Boards reward recognizing when subtle instability outweighs reassurance, then selecting nursing actions that protect airway, circulation, and neurologic status before routine tasks.