A 62-year-old man with type 2 diabetes and acute stroke presents with severe hyperglycemia (glucose 850 mg/dL), serum osmolality 340 mOsm/kg, pH 7.32, and HCO₃⁻ 18 mEq/L. Serum ketones are negative. Which of the following is NOT a feature that distinguishes this presentation from pure DKA?

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