Management

As for diabetic ketoacidosis; however:

1. Unless the patient shows signs of hypovolaemia and tissue hypoperfusion, in which case colloid challenges should be given for prompt resuscitation, fluid replacement should be more gradual as the risk of cerebral oedema is higher. This can be with either 0.9% saline or, if the plasma sodium is high, 0.45% saline at a rate of 100-200 ml/h.

2. The plasma sodium rises with treatment, even with 0.45% saline, and can often increase in the first few days to 160-170 mmol/l before gradually declining thereafter. Aim to correct slowly.

3. Serum phosphate and magnesium levels fall rapidly with this condition; replacement may be needed as guided by frequently taken plasma levels.

4. Patients may be hypersensitive to insulin and require lower doses.

5. Unless otherwise contraindicated, these patients should be fully heparinised until full recovery (which may take >5 days).

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