20 y/o male with a history of Type 1 Diabetes Mellitus brought in by ambulance to the emergency department with vomiting, myalgias, dry mouth, polyuria, abdominal pain, shortness of breath, and confusion after not taking insulin for one week. 

Diagnosis: Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. (Like most of us have seen in our organic chemistry classes.) Since ketones are common molecular ingredients in sugar, patients with DKA can have sweet-smelling breath. 

Shortness of breath (tachypnea) can be seen in these patients, as their body is trying to blow off excess acid within the blood. 

  • Blood sugar level: If there isn’t enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise.
  • Serum ketone level: When your body breaks down fat and protein for energy, toxic acids known as ketones enter your bloodstream.
  • Blood pH: If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of various organs throughout your body. An ABG can assess the pH of blood. 

If left untreated, diabetic ketoacidosis can lead to coma or even death.