An 18-year-old male with type 1 diabetes mellitus comes to the Emergency Department complaining of thirst, dizziness, and frequent urination. He has not taken his insulin in 3 days. He looks emaciated and ill. On physical assessment of the patient and laboratory study which of the following are you most likely to find?

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A type 1 diabetic patient who has not taken his insulin for 3 days is likely to be in diabetic ketoacidosis (DKA). One would expect his blood glucose to exceed 400 mg/dl, his bicarbonate level to be much less than normal (below 20, usually), and his pH to be acid (less than 7.35). To compensate for metabolic acidosis, he will hyperventilate. (Rapid breathing is a respiratory compensation for metabolic acidosis, it helps patients exhale CO₂.) His breath should be "fruity" smelling because of the presence of ketones in his blood. He will have polyuria (frequent urination) because of the osmotic diuresis caused by excessive levels of glucose in his blood, and dizziness because of dehydration resulting from this diuresis.

An 18-Year-Old Male with Type 1 Diabetes Mellitus Comes to the Emergency