ABSTRACT
HONK is treated with a combination of intravenous fluid resuscitation and intravenous insulin. Care must be taken not to reduce the glucose levels or sodium concentration too rapidly, as the resultant osmotic shifts can result in fatal cerebral oedema. The insulin should therefore be started at a low rate (e.g. 3 units/h) and only isotonic (0.9%) saline should be prescribed. HONK also places the patient at high risk of thromboembolic events such as deep vein thrombosis, pulmonary embolism and stroke; therefore all patients should receive prophylactic heparin. The mortality rate of HONK approaches 30%, which is likely to be a reflection of the advanced age of many of the patients and the presence of underlying illness.
