The chest physician on the general medical take

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:

  1. capillary blood glucose above 11 mmol/L
  2. capillary ketones above 3 mmol/L or urine ketones ++ or more
  3. 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.

DKA guidelines 

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