ZyraDoc #38 - September 08, 2026

A 23-year-old female with a history of Type 1 DM presents to the ED complaining of severe abdominal pain, nausea, and persistent vomiting for the last 14 hours.

Her mother reports that the patient became progressively lethargic and confused over the morning.

The patient admits she missed her long-acting insulin doses over the last two days because she was feeling sick with a cold and couldn't keep food down.

Case Summary

Clinical Focus:

The diagnosis is Diabetic Ketoacidosis (DKA).

Aetiology/Cause:

Absolute insulin deficiency due to complete omission of basal insulin therapy during a concurrent metabolic stressor.
Acute viral or bacterial infection (upper respiratory tract infection) acting as an inflammatory counter-regulatory trigger.
Misconception regarding 'sick day rules' where the patient stopped insulin therapy entirely due to poor oral intake or decreased carbohydrate consumption.

Clinical Features:

Gastrointestinal distress including severe non-localized abdominal pain, nausea, and continuous vomiting.
Neurological compromise ranging from progressive lethargy, confusion, and drowsiness to altered mental status.
Signs of severe systemic volume depletion, including dry mucous membranes, delayed capillary refill, and tachycardia.
Kussmaul breathing (deep, rapid respirations) and a distinct sweet, fruity odor to the breath due to volatile acetone production.

Diagnosis and Investigations:

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