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As for DKA except:
- If plasma sodium is greater than 145mmol/l then half-normal saline is used
- Lower doses of insulin are required because there is greater insulin sensitivity.
An example insulin infusion rate is presented below. Check with local guidelines.
||insulin rate (u/hour)
If the blood glucose has not fallen by 10mmol/l after the first 2 hours of
treatment then the infusion rate should be doubled.
- there is a high risk of thromboembolism - give subcutaneous heparin.
- HONK has a lower total body potassium than in DKA and the plasma level
is more variable when treatment begins. The levels should be checked at 30mins
after starting insulin and then 2-hourly
- most patients with HONK can subsequently managed on oral hypoglycaemics
once the daily insulin requirement has fallen to about 20 units
Last reviewed 01/2018