A 68-year-old woman with type 2 diabetes presents to the emergency department with altered mental status. Her blood glucose is 850 mg/dL, serum osmolality is 330 mOsm/kg, and she has no ketones in her urine or serum. Which of the following is the most appropriate initial management step?

The correct answer to the question "A 68-year-old woman with type 2 diabetes presents to the emergency department with altered mental status. Her blood glucose is 850 mg/dL, serum osmolality is 330 mOsm/kg, and she has no ketones in her urine or serum. Which of the following is the most appropriate initial management step?" is Option B: Administration of intravenous 0.9% normal saline.

The other options — A) Intravenous insulin bolus followed by continuous infusion, C) Bicarbonate infusion for acidosis, D) Glucagon injection — are incorrect for this USMLE Exam Prep question. As explained above: This patient's presentation is consistent with Hyperosmolar Hyperglycemic State (HHS). Initial management prioritizes aggressive fluid resuscitation with isotonic saline to correct severe dehydration.