Ans. D: Severely elevated Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus (T2 DM). The syndrome is characterized by severe hyperglycemia, a marked increase in serum osmolality and dehydration without accumulation of beta-hydroxybutyric or acetoacetic ketoacids. Significant ketogenesis is restrained by the ability of the pancreas to secrete small amount of insulin. Prolonged phase of osmotic diuresis leads to severe depletion of body water, which exceeds that of sodium, resulting in hypeonic dehydration. These children, usually obese adolescents with T2 DM, present with signs of severe dehydration and depressed mental status but continue to have increased rather than decreased urine output and are at increased risk of developing rhabdomyolysis and malignant hypehermia.