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HardEndocrinologyHyperosmolar hyperglycaemic stateuk-plab-1

A 70-year-old man with type 2 diabetes presents confused, severely dehydrated and drowsy. His capillary glucose is 45 mmol/L, osmolality is markedly elevated, and ketones are not raised. Hyperosmolar hyperglycaemic state is diagnosed. What is the most important initial management priority?

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