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What Is Hyperglycemic Hyperosmolar Syndrome?

Hyperglycemic Hyperosmolar Syndrome At The Onset Of Type 2 Diabetes Mellitus In An Adolescent Male

Hyperglycemic Hyperosmolar Syndrome At The Onset Of Type 2 Diabetes Mellitus In An Adolescent Male

Go to: CASE PRESENTATION A 15-year-old African American male was brought to the emergency department by ambulance in an obtunded state. The patient presented with a two-day history of vomiting, diarrhea, abdominal pain, general malaise and emotional distress. Before presentation, the patient experienced a recent history of polyuria and polydipsia of unknown duration. The patient did not have a primary care physician and this was his initial presentation to medical care. On arrival in the emergency room, the patient had a Glasgow Coma Scale score of 9. On examination, the patient was obese, with a body mass index (BMI) of 33 kg/m2. His blood pressure was 112/57 mmHg, with a heart rate of 146 beats/min (normal 60 beats/min to 100 beats/min), a respiratory rate of 60 breaths/min (normal 12 breaths/min to 16 breaths/min) with Kussmaul respirations and a temperature of 38.4°C. The patient’s pupillary response was sluggish and the patient was noted to have dry mucous membranes. Skin examination of the patient revealed acanthosis nigricans along the nape of his neck. The patient’s abdomen was slightly distended but soft. Initial laboratory investigations confirmed a diagnosis of diabetes (Table 1). Of note, the patient’s blood glucose level was markedly elevated at 90.9 mmol/L (normal 3.4 mmol/L to 6.3 mmol/L), serum osmolality 454 mOsm/kg (normal 275 mOsm/kg to 295 mOsm/kg), pH 6.97 (normal 7.35 to 7.41), PCO2 23 mmHg (normal 38 mmHg to 50 mmHg), HCO3−5 mEq/L (normal 20 mEq/L to 25 mEq/L), Na+ 141 mEq/L (normal 135 mEq/L to 145 mEq/L with ‘corrected’ Na+ for hyperglycemia 165 mEq/L), K+ 8.4 mEq/L (normal 3.5 mEq/L to 5.0 mEq/L), and 1+ urine ketones. Hemoglobin A1C was elevated at 13.4% (normal 4.0% to 6.0%), indicating longstanding hyperglycemia. Other than some Continue reading >>

Hyperosmolar Non-ketotic Hyperglycaemia

Hyperosmolar Non-ketotic Hyperglycaemia

hyperglycemic hyperosmolar state (HHS) Hperglycemic hyperosmolar state (HHS) previously known as hyperosmolar nonketotic (HONK) coma is a syndrome characterized by extreme elevations in serum glucose concentrations, hyperosmolality and dehydration without significant ketosis (1,2). characteristic features that differentiate it from other hyperglycaemic states such as DKA are: hypovolaemia marked hyperglycaemia (30 mmol/L or more) without significant hyperketonaemia (7.3, bicarbonate >15 mmol/L) osmolality usually 320 mosmol/kg or more N.B. - a mixed picture of HHS and DKA may occur (2) Incidence of HHS is unknown but is thought to be <1% of hospital admissions in patients with diabetes it is common in elderly patients with type 2 diabetes, but HHS has also been reported in children (in infants, especially those with 6q24-related transient neonatal diabetes mellitus ) young adults in type 1 diabetes subjects in children it is less frequent when compared to diabetic ketoacidosis (DKA) mortality rate is estimated to be as high as 20% (10 times higher than in diabetic ketoacidosis) (1). Gradually increasing polyuria and polydipsia will result in profound dehydration and electrolyte loss in a patient. in adults with HHS, fluid loss is estimated to be twice as those with DKA signs of dehydration may be less evident due to hypertonicity which preserves intravascular volume (1) Osmolality can be calculated from the formula: osmolality = 2(Na+K) + urea + glucose Note that serum sodium may be low, despite the fact that the patient is severely hyperosmolar. This is due to the redistribution of fluid into the extracellular fluid (secondary to the high glucose level). Reference: 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 >>

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 >>

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 >>

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 >>

Diabetic Coma And Type 2 Diabetes

Diabetic Coma And Type 2 Diabetes

A diabetic coma could happen when your blood sugar gets too high -- 600 milligrams per deciliter (mg/dL) or more -- causing you to become very dehydrated. It usually affects people with type 2 diabetes that isn’t well-controlled. It’s common among those who are elderly, chronically ill, and disabled. Doctors aren’t sure why, but they think they these people may not realize they’re thirsty or may not be able to get enough to drink. This is a serious condition, and if it isn’t spotted soon and treated quickly, it could be fatal. Knowing the symptoms can help you stay safe. If you have diabetes and you’ve had a heavy thirst and gone to the bathroom more often than usual for a few weeks, check with your doctor -- especially if your blood sugar isn’t well-controlled. As your body loses more and more water, you may notice: Drowsiness Altered mental state Restlessness Inability to speak Visual problems Paralysis These factors may lead to dehydration and coma: Once your doctor spots the early signs, he may send you to the hospital. You’ll get an IV to replace lost fluids and electrolytes such as potassium. And you’ll get insulin or other medication to control your blood sugar. The coma can lead to death if left untreated. Take these simple steps to help protect yourself: Check your blood sugar regularly, as your doctor recommends. Know your target blood sugar ranges and what to do if the readings are too high. Plan how often to check your blood sugar when you’re sick. Take extra care of yourself if you’re ill. Continue reading >>

Hyperosmolar Hyperglycemic Nonketotic Syndrome

Hyperosmolar Hyperglycemic Nonketotic Syndrome

Tweet Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), also known as Hyperosmolar Hyperglycaemic State (HHS) is a dangerous condition resulting from very high blood glucose levels. HHNS can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes. Usually, HHNS is brought on by an illness or infection. What are the major warning signs of HHS for people with diabetes? Elevated blood sugar levels Extreme thirst Warm skin without sweat Fever Confusion or feeling sleepy Vision loss Hallucinations Nausea Weakness down one side of the body Who is at risk of Hyperosmolar Hyperglycaemic State? Periods of illness can significantly raise blood glucose levels, which could lead to Hyperosmolar Hyperglycaemic State (HHS) if medication is not sufficient to lower sugar levels. Having blood glucose levels above 33 mmol/l (600 mg/dl) for extended periods of time presents a risk of HHS occurring. Some serious complications of diabetes, such as Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), usually manifest themselves amongst older people, who may be less aware of high blood glucose levels and how to treat them. What happens to diabetics who get HHNS? When HHNS affects a person with diabetes, blood sugar levels rise and the body passes excess sugar into the urine. This causes regular bathroom trips, and over time this affects the colour of the liquid. Dehydration can occur if you do not drink liquid regularly, and this can become severe and lead to coma, seizures and even death. What is the best way for people with diabetes to avoid HHNS? If you keep on top of your blood sugar levels, it is possible to avoid HHNS. By checking blood glucose regularly, people with diabetes can take action if a reading falls outside their target blood glucose ra 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 >>

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 >>

Hyperglycemic Hyperosmolar State: An Emerging Pediatric Problem

Hyperglycemic Hyperosmolar State: An Emerging Pediatric Problem

In his 1886 Bradshawe lecture on diabetic coma, Dreschfeld described a relatively uncommon form that he and other European authors had noted, in which dyspnea and the acetone smell of the breath were absent, and the urine did not contain acetone or aceto-acetic acid.1 He described a clinical presentation of shock occurring chiefly, but not exclusively, in older people who had diabetes symptoms for some time and were, “still stout and well-nourished at the time of attack.” Despite this early description and occasional subsequent reports of diabetic coma without significant ketosis/acidosis,2,3 the report of Sament and Schwartz4 in 1957 is widely credited as the original description of what has been variously referred to as hyperosmolar nonketotic coma, hyperglycemic hyperosmolar nonketotic syndrome, hyperosmolar nonacidotic uncontrolled diabetes, diabetic hyperosmolar state, and hyperglycemic hyperosmolar coma or syndrome (HHS). To access this article, please choose from the options below You searched for T2D in All Content Showing: 1-20 You searched for T2D in All Content Showing: 21-40 You searched for T2D in All Content Showing: 41-60 You searched for T2D in All Content Showing: 61-80 You searched for T2D in All Content Showing: 81-100 You searched for T2D in All Content Showing: 101-120 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

What is diabetic hyperglycemic hyperosmolar syndrome? Hyperglycemic hyperosmolar syndrome (HHS) is a potentially life-threatening condition involving extremely high blood sugar, or glucose, levels. Any illness that causes dehydration or reduced insulin activity can lead to HHS. It’s most commonly a result of uncontrolled or undiagnosed diabetes. An illness or infection can trigger HHS. Failure to monitor and control blood glucose levels can also lead to HHS. When your blood sugar gets too high, the kidneys try to compensate by removing some of the excess glucose through urination. If you don’t drink enough fluids to replace the fluid you’re losing, your blood sugar levels spike. Your blood also becomes more concentrated. This can also occur if you drink too many sugary beverages. This condition is called hyperosmolarity. Blood that’s too concentrated begins to draw water out of other organs, including the brain. Some possible symptoms are excessive thirst, increased urination, and fever. Symptoms may develop slowly and increase over a period of days or weeks. Treatment involves reversing or preventing dehydration and getting blood glucose levels under control. Prompt treatment can relieve symptoms within a few hours. Untreated HHS can lead to life-threatening complications, including dehydration, shock, or coma. Go to an emergency room or call 911 if you have symptoms of HHS. This is a medical emergency. HHS can happen to anyone. It’s more common in older people who have type 2 diabetes. Symptoms may begin gradually and worsen over a few days or weeks. A high blood sugar level is a warning sign of HHS. The symptoms include: excessive thirst high urine output dry mouth weakness sleepiness a fever warm skin that doesn’t perspire nausea vomiting weight loss leg 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: Feeling weak Nausea Weight loss Dry mouth, dry tongue Fev Continue reading >>

Hyperosmolar Hyperglycemic State: A Historic Review Of The Clinical Presentation, Diagnosis, And Treatment

Hyperosmolar Hyperglycemic State: A Historic Review Of The Clinical Presentation, Diagnosis, And Treatment

Go to: The hyperosmolar hyperglycemic state (HHS) is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. The exact incidence of HHS is not known, but it is estimated to account for <1% of hospital admissions in patients with diabetes (1). Most cases of HHS are seen in elderly patients with type 2 diabetes; however, it has also been reported in children and young adults (2). The overall mortality rate is estimated to be as high as 20%, which is about 10 times higher than the mortality in patients with diabetic ketoacidosis (DKA) (3–5). The prognosis is determined by the severity of dehydration, presence of comorbidities, and advanced age (4,6,7). Treatment of HHS is directed at replacing volume deficit and correcting hyperosmolality, hyperglycemia, and electrolyte disturbances, as well as management of the underlying illness that precipitated the metabolic decompensation. Low-dose insulin infusion protocols designed for treating DKA appear to be effective; however, no prospective randomized studies have determined best treatment strategies for the management of patients with HHS. Herein, we present an extensive review of the literature on diabetic coma and HHS to provide a historical perspective on the clinical presentation, diagnosis, and management of this serious complication of diabetes. History of Diabetic Coma and HHS In 1828, in the textbook Versuch einer Pathologie und Therapie des Diabetes Mellitus, August W. von Stosch gave the first detailed clinical description of diabetic coma in an adult patient with severe polydipsia, polyuria, and a large amount of glucose in the urine followed by progressive decline in mental status and death (8). Several case reports followed this publication, describing p Continue reading >>

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