Diagnose It Answer — April 2, 2026
ALL CLUES
19-year-old male presents with nausea, vomiting, and abdominal pain for the past 12 hours. Reports feeling extremely tired.
Type 1 diabetic diagnosed at age 8. States he ran out of insulin 4 days ago and hasn't been able to afford a refill.
HR 112, RR 28 with deep labored breathing, BP 96/58, temp 37.1°C, blood glucose 498 mg/dL on fingerstick.
Fruity odor noted on breath. Mucous membranes dry, skin tenting present. Patient is confused and disoriented to time and place.
ABG: pH 7.18, HCO₃ 10, pCO₂ 28. Serum ketones large. Anion gap 26. Na 131, K 5.8 (corrected sodium ~137 mEq/L when adjusted for hyperglycemia). PaCO₂ higher than expected by Winter's formula — concurrent respiratory fatigue from prolonged Kussmaul breathing limits CO₂ elimination.
Diabetic ketoacidosis is a life-threatening emergency caused by insulin deficiency, leading to uncontrolled fat breakdown and ketone production that acidifies the blood. Nurses must assess for Kussmaul respirations, fruity breath, and an anion gap above 12 mEq/L. Treatment requires insulin infusion, aggressive IV fluid resuscitation, and electrolyte replacement — potassium must be confirmed above 3.3 mEq/L before starting insulin to prevent fatal cardiac dysrhythmias.
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