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What Is Hyperglycemic Hyperosmolar Syndrome?

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose, hyperosmolarity, and little or no ketosis. With the dramatic increase in the prevalence of type 2 diabetes and the aging population, this condition may be encountered more frequently by family physicians in the future. Although the precipitating causes are numerous, underlying infections are the most common. Other causes include certain medications, non-compliance, undiagnosed diabetes, substance abuse, and coexisting disease. Physical findings of hyperosmolar hyperglycemic state include those associated with profound dehydration and various neurologic symptoms such as coma. The first step of treatment involves careful monitoring of the patient and laboratory values. Vigorous correction of dehydration with the use of normal saline is critical, requiring an average of 9 L in 48 hours. After urine output has been established, potassium replacement should begin. Once fluid replacement has been initiated, insulin should be given as an initial bolus of 0.15 U per kg intravenously, followed by a drip of 0.1 U per kg per hour until the blood glucose level falls to between 250 and 300 mg per dL. Identification and treatment of the underlying and precipitating causes are necessary. It is important to monitor the patient for complications such as vascular occlusions (e.g., mesenteric artery occlusion, myocardial infarction, low-flow syndrome, and disseminated intravascular coagulopathy) and rhabdomyolysis. Finally, physicians should focus on preventing future episodes using patient education and instruction in self-monitoring. Hyperosmolar hyperglycemic state is a relatively common, life-threatening endocrine emergency that is reported in all age groups,1 but it most Continue reading >>

Managing Hyperosmolar Syndrome

Managing Hyperosmolar Syndrome

Go to site For Pet Owners Hyperosmolar syndrome is an uncommon complication of untreated feline diabetes mellitus. In animals in which target tissue resistance to insulin plays a role in the disease, insulin levels can be elevated. In these cases, ketosis is suppressed and plasma glucose concentrations can become very high. Diagnosis Physical examination often reveals profound dehydration, and the cat is typically lethargic, extremely depressed, or comatose. The severity of the hyperosmolality correlates directly with the severity of these signs. Hyperosmolar syndrome represents an emergency situation. Affected cats will become progressively weaker, anorexic, lethargic, and drink less. Ultimately, blood glucose levels become so high that osmosis shifts water from brain cells and coma results. Management guidelines Goals of management include correcting fluid deficits and electrolyte balance associated with severe dehydration, reducing blood glucose via insulin therapy, correcting the hyperglycemic, hyperosmolar state, and managing concurrent diseases. Fluid therapy is critical to alleviate this syndrome, especially in the first 4 to 6 hours of management. The goal is to reduce blood glucose at the rate of 50 mg/dL/hr. When the blood glucose approaches 300 mg/dL, the IV fluid selection should be changed to 5% dextrose solution. Intravenous isotonic fluid and insulin therapy usually resolve hyperosmolality, but must be done slowly to minimize the shift of water from the extracellular to the intracellular compartment. Delay insulin therapy (typically 4–6 hours) until fluid therapy has improved the cat’s condition, corrected dehydration and improved urine production, hyperglycemia, hyperosmolality, and electrolyte levels. Evaluation of management When evaluating the eff Continue reading >>

Hyperglycemic Hyperosmolar Syndrome

Hyperglycemic Hyperosmolar Syndrome

Ads by Google Hyperglycemic hyperosmolar syndrome (HHS) is a type2 diabetes complication involving extremely high blood sugar levels without ketones. What is hyperglycemic hyperosmolar syndrome? Diabetic HHS is a condition of severely high blood sugar, extreme lack of water (dehydration), and decreased consciousness. Generally, there may be ketone’s build-up in the body often mild. HHS is usually developed among type2 diabetes and occasionally among undiagnosed patients. Alternative names are hyperglycemic-hyperosmolar coma, nonketotic-hyperglycemic hyperosmolar coma (NKHHC), or hyperosmolar-nonketotic coma (HONK). Most often, this condition has brought on by Poorly managed diabetes, Infection, Severe illness (such as infection, heart attack or stroke, and resent surgery), Poor kidney function, Older age, Medication increased fluid loss (such as diuretic). The kidney try removing this high blood glucose through urine, if you do not drink enough liquid or taking sugar-rich fluid makes it difficult for the kidney to remove excess glucose. HHS symptoms are coma, confusion, convulsions, fever, increased thirst, increased urination, lethargy, nausea, and fatigue. The condition worsens over time with severe symptoms such as dysfunctional movement, loss of feeling/function of muscles, and impaired speech. HHS diagnosis and tests HHS diagnosis is by examining the symptoms such as extreme dehydration, high fever, increased heart rate, and drop in systolic BP. Tests for diagnosis of HHS are blood osmolarity (concentration), BUN & creatinine levels, blood sodium level, ketone test, and blood-glucose test. Other evaluation tests include blood cultures, chest x-ray, electrocardiogram (ECG), and urinalysis. HHS treatment goal is to correct dehydration, normalize BP, improve urine o Continue reading >>

Diabetic Hyperosmolar Syndrome

Diabetic Hyperosmolar Syndrome

Print Overview Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes. It's often triggered by illness or infection. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your urine. Left untreated, diabetic hyperosmolar syndrome can lead to life-threatening dehydration. Prompt medical care is essential. Symptoms Diabetic hyperosmolar syndrome can take days or weeks to develop. Possible signs and symptoms include: Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher Excessive thirst Dry mouth Increased urination Warm, dry skin Fever Drowsiness, confusion Hallucinations Vision loss Convulsions Coma When to see a doctor Consult your doctor if your blood sugar is persistently higher than the target range your doctor recommends, or if you have signs or symptoms of diabetic hyperosmolar syndrome, such as: Excessive thirst Increased urination Warm, dry skin Dry mouth Fever Seek emergency care if: Your blood sugar level is 400 mg/dL (22.2 mmol/L) or higher and doesn't improve despite following your doctor's instructions for treatment. Don't wait until your blood sugar is high enough to cause diabetic hyperosmolar syndrome. You have confusion, vision changes or other signs of dehydration. Causes Diabetic hyperosmolar syndrome may be triggered by: Illness or infection Not following a diabetes treatment plan or having an inadequate treatment plan Certain medications, such as water pills (diuretics) Sometimes undiagnosed diabetes results in diabetic hyperosmolar syndrome. Risk factors Your risk of developing diabetic hyperosmolar synd Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.[4] Symptoms include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of consciousness.[2] Onset is typically over days to weeks.[3] Complications may include seizures, disseminated intravascular coagulopathy, mesenteric artery occlusion, or rhabdomyolysis.[2] The main risk factor is a history of diabetes mellitus type 2.[4] Occasionally it may occur in those without a prior history of diabetes or those with diabetes mellitus type 1.[3][4] Triggers include infections, stroke, trauma, certain medications, and heart attacks.[4] Diagnosis is based on blood tests finding a blood sugar greater than 30 mmol/L (600 mg/dL), osmolarity greater than 320 mOsm/kg, and a pH above 7.3.[2][3] Initial treatment generally consists of intravenous fluids to manage dehydration, intravenous insulin in those with significant ketones, low molecular weight heparin to decrease the risk of blood clotting, and antibiotics among those in whom there is concerns of infection.[3] The goal is a slow decline in blood sugar levels.[3] Potassium replacement is often required as the metabolic problems are corrected.[3] Efforts to prevent diabetic foot ulcers are also important.[3] It typically takes a few days for the person to return to baseline.[3] While the exact frequency of the condition is unknown, it is relatively common.[2][4] Older people are most commonly affected.[4] The risk of death among those affected is about 15%.[4] It was first described in the 1880s.[4] Signs and symptoms[edit] Symptoms of high blood sugar including increased thirst (polydipsia), increased volume of urination (polyurea), and i Continue reading >>

Management Of Decompensated Diabetes. Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome.

Management Of Decompensated Diabetes. Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome.

Abstract DKA and HHS represent two extremes in the spectrum of decompensated diabetes mellitus. Their pathogenesis is related to absolute or relative deficiency in insulin levels and elevations in insulin counterregulatory hormones that lead to altered metabolism of carbohydrate, protein, and fat and varying degrees of osmotic diuresis and dehydration, ketosis, and acidosis. In DKA, insulin deficiency and ketoacidosis are the prominent features of the clinical presentation, and insulin therapy is the cornerstone of therapy. In HHS, hyperglycemia, osmotic diuresis, and dehydration are the prominent features, and fluid replacement is the cornerstone of therapy. As many as one-third of patients may have mixed features of both DKA and HHS. Because the three-pronged approach to therapy for either DKA or HHS consists of fluid administration, intravenous insulin infusion, and electrolyte replacement, mixed cases are managed using the same approach. The therapeutic regimen is tailored according to the prominent clinical features present. In adult patients with mixed features, fluids may be administered more rapidly than they would be in younger patients, or in patients with DKA alone, because the risk for fatal cerebral edema in adults is low and the consequences of undertreatment include vascular occlusion and increased mortality. In younger patients with mixed features, rapid correction of metabolic abnormalities and, consequently, of hyperosmolarity by administration of hypotonic fluids and insulin should be avoided to decrease the risk for precipitating cerebral edema. In addition, if ketoacidosis has been a prominent feature in a mixed case, the patient may have type 1 diabetes with no residual pancreatic islet beta cell secretion and may subsequently need ongoing, life-lo Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

HHS; Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK); Hyperglycemic hyperosmolar non-ketotic state; Diabetes - hyperosmolar Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones. Causes HHS is a condition of: Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by: Infection Other illness, such as heart attack or stroke Medicines that decrease the effect of insulin in the body Medicines or conditions that increase fluid loss Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high. The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain. Risk factors include: Symptoms Symptoms may include any of the following: Symptoms may get worse over days or weeks. Other symptoms Continue reading >>

Acute Complications Of Diabetes - Hyperosmolar Hyperglycemic Nonketotic State

Acute Complications Of Diabetes - Hyperosmolar Hyperglycemic Nonketotic State

- [Voiceover] Diabetes mellitus and its associated complications are the 8th leading cause of death worldwide. Now normally we think of both type 1 and type 2 diabetes as being more chronic conditions that result in complications such as kidney disease and cardiovascular disease over years to decades. And this is true, but there are also a couple of very important acute complications of diabetes mellitus. And these are known as diabetic ketoacidosis, or DKA for short, and hyperosmolar hyperglycemic non-ketotic state, or HHNS for short. And unfortunately these acute complications can be very serious, especially HHNS, which has a mortality rate of eight to 20%. In this video, let's discuss hyperosmolar hyperglycemic non-ketotic state. Now the name hyperosmolar hyperglycemic non-ketotic state is pretty descriptive in regards to the metabolism that underlies the disease. However, it does not really describe the clinical presentation of the condition. So let's start with that. And most commonly, someone with HHNS has already been diagnosed with diabetes, and this occurs sometime after their initial diagnosis. And since they have diabetes, they likely will have hyperglycemia, which is one of the defining characteristics of diabetes mellitus. And as we'll discuss in just a minute, it's this hyperglycemia that's driving a lot of the events that are occurring in HHNS. Now over a period of days to weeks, someone with HHNS is gonna become pretty sick, and they're gonna have symptoms of fatigue, maybe some weight loss. They're gonna have extreme thirst and frequent urination. On physical exam they'll have signs of dehydration, such as a high heart rate, known as tachycardia, a low blood pressure known as hypotension, the mucus membranes in their mouth may be dry, and their skin may Continue reading >>

Hyperosmolar Hyperglycemic State (hhs)

Hyperosmolar Hyperglycemic State (hhs)

Hyperosmolar hyperglycemic state is a complication of diabetes mellitus that most often occurs in type 2 diabetes. Symptoms of hyperosmolar hyperglycemic state include extreme dehydration and confusion. Hyperosmolar hyperglycemic state is diagnosed by blood tests that show very high levels of glucose and very concentrated blood. There are two types of diabetes mellitus, type 1 and type 2. In type 1 diabetes, the body produces almost no insulin, a hormone produced by the pancreas that helps sugar (glucose) move from the blood into the cells. In type 2 diabetes, the body produces insulin, but cells fail to respond normally to the insulin. In both types of diabetes. the amount of sugar (glucose) in the blood is elevated. If people with type 1 diabetes receive no insulin, or they need more insulin because of an illness, fat cells begin breaking down to provide energy. Fat cells that break down produce substances called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). Diabetic ketoacidosis is a dangerous, sometimes life-threatening, disorder. Because people with type 2 diabetes produce some insulin, ketoacidosis does not usually develop even when type 2 diabetes is untreated for a long time. However, with hyperosmolar hyperglycemic state, the blood glucose levels can become extremely high (even exceeding 1,000 mg per deciliter of blood). Such very high blood glucose levels cause the person to pass large amounts of urine, which eventually causes severe dehydration and makes the person's blood abnormally concentrated (hyperosmolar). Thus, the disorder is called hyperosmolar hyperglycemic state. Symptoms The main symptom of hyperosmolar hyperglycemic state is a mental change. The change ranges from mild confusion and disorientatio Continue reading >>

What Is Hyperosmolar Hyperglycemic Nonketotic Syndrome?

What Is Hyperosmolar Hyperglycemic Nonketotic Syndrome?

Having diabetes means that there is too much sugar (glucose) in your blood. When you eat food, your body breaks down much of the food into glucose. Your blood carries the glucose to the cells of your body. An organ in your upper belly, called the pancreas, makes and releases a hormone called insulin when it detects glucose. Your body uses insulin to help move the glucose from the bloodstream into the cells for energy. When your body does not make insulin (type 1 diabetes), or has trouble using insulin (type 2 diabetes), glucose cannot get into your cells. The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome (HHNS). It is very rare in people with type 1 diabetes. HHNS is an emergency caused by very high blood sugar, often over 600 mg/dL. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. This makes you urinate more and you lose too much body fluid, causing dehydration. As you lose fluids, your blood becomes thicker and your blood sugar level gets too high for the kidneys to be able to fix. With the high blood sugar and dehydration there is also an imbalance of minerals, especially sodium and potassium in the blood. The imbalance of fluids, glucose, and minerals in the body can lead to severe problems, such as brain swelling, abnormal heart rhythms, seizures, coma, or organ failure. Without rapid treatment, HHNS can cause death. What can I expect in the hospital? You will need to stay in the hospital in order to bring your blood sugar level under control and treat the cause of the HHNS. Several things may be done while you are in the ho Continue reading >>

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Clinical Features, Evaluation, And Diagnosis

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Clinical Features, Evaluation, And Diagnosis

INTRODUCTION Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS, also known as hyperosmotic hyperglycemic nonketotic state [HHNK]) are two of the most serious acute complications of diabetes. DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here. The epidemiology, pathogenesis, and treatment of these disorders are discussed separately. DKA in children is also reviewed separately. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) Continue reading >>

Hyperglycemic

Hyperglycemic

(redirected from hyperglycemic hyperosmolar nonketotic coma (HHNK)) Also found in: Dictionary. hyperglycemic [hi″per-gli-se´mik] 1. characterized by or causing hyperglycemia. 2. an agent that has this effect. hyperglycemic hyperosmolar nonketotic (HHNK) coma a metabolic derangement in which there is an abnormally high serum glucose level without ketoacidosis. It can occur as a complication of borderline and unrecognized diabetes mellitus, in pancreatic disorders that interfere with the production of insulin, as a complication of extensive burns, and in conditions marked by an excess of steroids, as in steroid therapy, or acute stress conditions, such as infection. It also may develop during total parenteral nutrition, hemodialysis, or peritoneal dialysis. Called also hyperosmolar nonketotic coma. Symptoms. The hyperglycemia of HHNK coma is usually extreme, with fasting blood sugar levels ranging from 600 to 3000 mg per 100 ml of blood. In contrast to typical diabetic coma, however, the serum acetone level is normal or only slightly elevated. This occurs because, although there is sufficient insulin available to avoid ketosis, there is not enough to metabolize the glucose and thereby relieve the hyperglycemia. Hyperosmolality, resulting from the extremely high concentration of sugar in the blood, causes a shift of water from the intracellular fluid (the less concentrated solution) into the blood (the higher concentrated solution). This results in cellular dehydration. Another symptom of HHNK coma, polyuria, occurs because the high plasma osmolality prevents the normal osmotic return of water to the blood by the renal tubules, and it is excreted in the urine. This leads to a decreased blood volume, which severely hampers the kidney's excretion of glucose and a vicious Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

HHS; Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK); Hyperglycemic hyperosmolar non-ketotic state; Diabetes - hyperosmolar Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones. Causes HHS is a condition of: Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by: Infection Other illness, such as heart attack or stroke Medicines that decrease the effect of insulin in the body Medicines or conditions that increase fluid loss Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high. The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain. Risk factors include: Impaired thirst Older age Poor kidney function Poor management of diabetes, not following the treatment plan Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

HHS; Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK); Hyperglycemic hyperosmolar non-ketotic state; Diabetes - hyperosmolar Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones. Causes HHS is a condition of: Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by: Infection Other illness, such as heart attack or stroke Medicines that decrease the effect of insulin in the body Medicines or conditions that increase fluid loss Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high. The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain. Risk factors include: Impaired thirst Older age Poor kidney function Poor management of diabetes, not following the treatment plan Continue reading >>

Aggressive Fluid Resuscitation In Severe Pediatric Hyperglycemic Hyperosmolar Syndrome: A Case Report

Aggressive Fluid Resuscitation In Severe Pediatric Hyperglycemic Hyperosmolar Syndrome: A Case Report

Abstract Objective. This report describes a severe case of hyperglycemic hyperosmolar syndrome complicated by rhabdomyolysis, acute kidney injury, hyperthermia, and hypovolemic shock, with management centred upon fluid administration. Design. Case report. Setting. Pediatric intensive care unit in university teaching hospital. Patients. 12 years old adolescent female presenting with hyperglycemic hyperosmolar syndrome with a new diagnosis of type 2 diabetes mellitus. Intervention. Aggressive fluid resuscitation and insulin. Main results. The patient had a good outcome, discharged home on hospital day 6. Conclusions. Hyperglycemic hyperosmolar syndrome is associated with a number of complications. Management strategies are undefined, given the rarity of its presentation, and further studies are warranted. 1. Introduction Recent trends indicate a rising percentage of type two diabetes in the under eighteen population, with a prevalence of 0.22 cases per 1000 youth [1] amongst the American population. Hyperglycemic hyperosmolar syndrome (HHS), a rare pediatric complication of diabetes mellitus (DM), is characterized by the triad of hyperglycemia (typically > 600 mg/dL), hyperosmolality (serum osmolality >330 mOsm/L), and a mild metabolic acidosis (pH > 7.2). It portends a very poor prognosis, with mortality rates of between 10–50% in adults [2]. In children, similar mortality rates have been observed [3], although most of the literature is limited to case series and reports. In adults, documented major complications include thrombosis, rhabdomyolysis, renal failure, and irreversible cardiac arrhythmias [4]. A formal distinction between HHS and diabetic ketoacidosis (DKA) exists, with DKA typically presenting with lower levels of hyperglycemia, ketosis, and more significan Continue reading >>

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