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Honk(hiporosmolar non ketotik)

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  HIPOROSMOLAR NON KETOTIK Lita Septina Internal Medicine Dept Islamic University of Sumatera Utara   Acute Complication of Diabetes Mellitus   ã HyperOsmolar Non Ketotic Coma (HONK) ã Diabetic ketoacidosis (DKA) ã Hypoglycemia  Hyperosmolar Non Ketotic Coma ã In 1957 Summent and Schwarts described a syndrome of marked diabetic stupor with hyperglycemia and hyperosmolarity in the absence of ketosis. ã The syndrome has been given a number of names : nonketotic hyperosmolar coma, diabetic hyperosmolar state, hyperosmolar nonacidotic diabetes and hyperglycemia hyperosmolar state (HHS) (ADA) ã 17,5 cases per 100.000 person-years and 1 in 1000 admissions to the hospital, in US ã The mortality rate as high as 12% to 46%. The mortality rate increases with higher levels of serum osmolarity.  HONK: Differences from DKA  Patients usually older- typically 60 or more  Major pathophysiologic differences  longer uncompensated osmotic diuresis  greater volume depletion   Acidemia (pH > 7.3) and ketosis are mild  Higher mortality -  often 30-50%  primarily due to underlying vascular or infectious event  Occurs in Type 2 diabetics, often mild or unrecognized

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