FN: HONK

Question 1

The typical patient

Answer 1

1. usually T2DM, often new presentation
2. Usually older
3. Long hx (e.g. 1 wk)

Question 2

Metabolic derangement

Answer 2

1. Marked dehydration and glucose >35mM
2. No acidosis (no ketogenesis)
3. Osmolality >340 mosmol/kg

Question 3

Complications

Answer 3

Occlusive events are common: DVT, stroke - give LMWH

Question 4

Management

Answer 4

1. REhydrate wit 0.9% NS over 48h: may need 9L
2. Wait 1h before starting insulin
   a. it may not be needed
   b. Start low to avoid rapid changes in osmolality e.g. 1-3 u/hr
3. Look for precipitant
   a. MI
   b. Infection
4. Bowel infarct