What is the primary treatment for hyperglycemic hyperosmolar nonketotic state?

In the management of hyperglycemic hyperosmolar nonketotic state (HHNS), the primary treatment involves both fluid replacement and insulin therapy. This condition is characterized by severe hyperglycemia, elevated serum osmolarity, and significant dehydration, often occurring in individuals with poorly controlled diabetes, particularly type 2.

Fluid resuscitation is critical because it helps to reduce the serum osmolarity and restore normal blood volume, which is often depleted due to osmotic diuresis caused by high glucose levels. This hydration is essential before and during the administration of insulin.

Insulin therapy plays a dual role by not only facilitating the uptake of glucose by cells but also helping to decrease blood glucose levels significantly. The combination of intravenous fluids to restore volume and electrolyte balance, along with insulin to decrease hyperglycemia, is necessary to treat this serious condition effectively.

In summary, the correct answer highlights the necessity of addressing both fluid loss and high blood sugar levels in treating HHNS, effectively managing its complications and improving patient outcomes.