A 16 year old male with a day history of malaise, weakness and vomiting. He was diagnosed with Insulin dependent diabetes mellitus 3 years prviously. Which ONE of the following supports a diagnosis of diabetic ketoacidosis: 1) Abdominal pain at onset 2) A serum bicarbonate of 10 mmol/l 3) A serum glucose 14 mmol/l 4) Decreased appetite in the past few days 5) Shallow respirations

A 16 year old male with a day history of malaise, weakness and vomiting. He was diagnosed with Insulin dependent diabetes mellitus 3 years prviously. Which ONE of the following supports a diagnosis of diabetic ketoacidosis: 1) Abdominal pain at onset 2) A serum bicarbonate of 10 mmol/l 3) A serum glucose 14 mmol/l 4) Decreased appetite in the past few days 5) Shallow respirations  
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Answers-2 a-An unusual but recognised feature particularly in children. However does not support a diagnosis of DKA. b-Suggests metabolic acidosis. c-'Normoglycaemic DKA' can occur and a glucose of 14 doesn't rule out the diagnosis but it does not support the diagnosis. d-Usually patients are unwell with infections and anorexia. e-Respiratory compensation leads to rapid deep (Kussmaul's) breathing. (Dr Mike Mulcahy)
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