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- Characterized by severe hyperglycemia, hyperosmolality, and dehydration, in the absence of significant ketoacidosis (plasma glucose >600 mg/dL, arterial pH > 7.30, serum bicarbonate >18 meq/L, effective serum osmolality >320 mOsm/kg) 
- Initiated by osmotic diuresis due to hyperglycemia. Maintained by insulin levels sufficient to prevent lipolysis and subsequent ketogenesis, but inadequate to appropriately reduce blood glucose levels .
- Associated with proinflammatory state, reversed by effective hydration and insulin treatment .
- Usually seen in patients with type 2 diabetes (T2DM), in whom it may be the initial presentation. Occurs rarely in children or patients with type 1 diabetes  .