You realise this patient likely has a metabolic acidosis from DKA. You order a venous blood gas. This shows:

pH 7.00

pCO₂ 2.9 kPa

pO₂ 7.6 kPa

HCO₃ 7 mmol/L

Base Excess  -10 mEq/L

Lactate 3.0 mmol/L

Na 132 mmol/L

K 4.1 mmol/L

Glucose 17.2 mmol/L

Everything is well with the world again. You give a fixed rate insulin infusion, and all is well with the world again.

The Med SpR descends from heaven, riding on a cloud. “Dearest FY1,” he says in his dreamy god-like voice, “I’ll take it from here. Take a quick coffee break and see the next patient when you are ready.”

Score: 6/10 – you recovered well after using the wrong initial diagnostic test. See the DKA guidelines for diagnosis and management.