A chest xray is reported as normal.
As the penny drops that this may be a metabolic acidosis driving an increased respiratory rate with respiratory compensation, the medical registrar arrives. He doesn’t say a word to you. He does a venous blood gas on the patient and then on you as a painful reminder that breathlessness can have respiratory causes.
Score: 4/10 – the diagnosis of DKA rests upon:
- capillary blood glucose above 11 mmol/L
- capillary ketones above 3 mmol/L or urine ketones ++ or more
- venous pH less than 7.3 and/or bicarbonate less than 15 mmol/L
This means a VBG is imperative early on. You gave fluids early on however, so the patient was still alive when the registrar arrived in his superman costume.