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Case presentation
A 18-year-old woman presents to the emergency department complaining of vomiting, polyuria and fever. PMH. She suffers from type 1 diabetes mellitus and has recently developed a urinary tract infection. DH. She takes insulin glargine 11 units SC nightly. She reports losing her appetite during her illness so hasn’t been taking her prescribed insulin aspart before meals.
On examination
She is breathing deeply and there is a ‘fruity’ smell on her breath. Temperature 37.4°C, HR 90/min and regular, BP 110/76 mmHg, RR 24/min, O2 sat 99% on air. Diffuse abdominal tenderness. Urinalysis showed glucose 3+, ketones 3+, nitrites 2+, leukocytes 2+, blood trace, protein trace.
Investigations
WCC 16.3 x 109/L (4.0-11.0), Na+ 133 mmol/L (137-144), K+ 4.6 mmol/L (3.5-4.9), glucose 22 mmol/L (3.0-6.0), arterial pH 7.12 (7.35-7.45), bicarbonate 9 mmol/L (21-29)
