“Hey, remember that case of the pregnant woman with vomiting, who had ketonuria and glycosuria and turned out to have hyperemesis?” you overhear your colleague shouting across the room in your direction for no particular reason.
“Yeah,” you reply, slightly concerned.
“I was just thinking how similar that was to that patient with pancreatitis who had ketones and glucose in the urine. Makes you think, doesn’t it?”
“It sure does,” you mutter as you nod your head sagely.
The insulin has begun. Fifteen minutes later, the patient’s observations have worsened to Pulse 132, BP 85/60 mmHg, Temp 37.2, RR 25, Sats 100% oa. Is this definitely DKA? Why is she worsening on insulin? What should you do next?
500ml of 0.9% N.Saline stat and review