Hyperosmolar Nonketotic Syndrome (HONK)

First Things First (assess & treat for the following)

Determine if pt is hemodynamically stable and begin resuscitation ABCs if needed.
Look for precipitating factors—infection, myocardial infarction, cerebrovascular accident, mesenteric ischemia, acute pancreatitis and use of medications such as steroids, thiazide diuretics, calcium-channel blockers, propranolol and phenytoin.
Mortality can approach 15% compared to < 2% in DKA. Mortality is usually due to an underlying medical condition.

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