What condition is indicated by a blood glucose level of 650 mg/dl, bicarbonate of 21, and a pH of 7.35 in a patient presenting with polydipsia and polyuria?

The scenario describes a patient with a significantly elevated blood glucose level of 650 mg/dl, a relatively normal bicarbonate level of 21, and a pH of 7.35, along with symptoms of polydipsia and polyuria.

This clinical picture aligns with Hyperglycemic Hyperosmolar Nonketotic State (HHNS), a condition typically seen in patients with type 2 diabetes mellitus. HHNS is characterized by severe hyperglycemia and high plasma osmolality, leading to osmotic diuresis and dehydration. The bicarbonate level of 21 indicates that metabolic acidosis is not significant in this case, which helps differentiate it from diabetic ketoacidosis, where one would expect a much lower bicarbonate level and acidosis, as well as the presence of ketones.

The blood pH of 7.35 signals that the patient is acidotic but not to the extent of diabetic ketoacidosis. In HHNS, such high glucose levels do not lead to ketone production, which aligns with what is observed in this patient. The combination of severe hyperglycemia, a normal bicarbonate level, reduced pH, and typical symptoms is indicative of HHNS rather than diabetic ketoacidosis or simply a