In HHNS, which statement is true regarding ketone production?

• A. Ketones are produced in large amounts
• B. Ketones are produced only at night
• C. Ketones are temporarily stored
• D. Ketones are not produced

Answer: (D)

In HHNS, there is enough circulating insulin to prevent significant fat breakdown and ketone formation. The main problem is extremely high blood glucose causing osmotic diuresis and dehydration, not ketosis. Ketone production requires extensive lipolysis and ketogenesis, which are suppressed when some insulin is present. So the statement that ketones are not produced is the best fit because HHNS typically features minimal to no ketosis, unlike DKA where there is substantial ketone production. The other options don’t fit: ketosis in large amounts doesn’t occur in HHNS, ketones aren’t specifically produced only at night, and they aren’t stored temporarily as a defining feature of the condition.