A 72-year-old diabetic female becomes stuporous after recent excessive diuresis. What is the most likely diagnosis?

The scenario describes a 72-year-old female with diabetes who is stuporous after experiencing recent excessive diuresis. In this case, the most likely diagnosis is hyperglycemic hyperosmolar state (HHS).

Hyperglycemic hyperosmolar state, commonly seen in elderly patients with type 2 diabetes, is characterized by extremely high blood glucose levels and significant dehydration due to osmotic diuresis caused by elevated glucose. The excessive diuresis can lead to significant fluid and electrolyte loss, which, combined with the high serum glucose levels, results in severe dehydration and can cause altered mental status, including stupor.

In this patient, the diabetes and recent excessive diuresis suggest that she may be in a state of hyperglycemia with high serum osmolality, consistent with HHS. The stupor indicates a significant disturbance in her mental status, which is a hallmark of this condition.

Other conditions such as diabetic ketoacidosis and lactic acidosis may cause altered mental status as well, but the context of excessive diuresis and the patient's age and history point more specifically to HHS. Hypoglycemic coma could be a consideration, yet it is less likely in a patient who is known to be diabetic and recently experiencing high glucose