Clinical features

• Fluid depletion is greater, blood glucose levels often higher, coma more frequent and mortality much higher than in diabetic ketoacidosis.

• Confusion, agitation and drowsiness that may persist for 1-2 weeks.

• A metabolic acidosis may be present but is not usually profound; ketoacidosis is not a major feature.

• Hyperosmolality may predispose to thrombotic events; this is the major cause of mortality. Severe hyperosmolality does not always occur.

• Focal neurological signs and disseminated intravascular coagulation are occasionally recognised.

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