#0003
Diabetic ketoacidosis after missed insulin
Patient
19y · Female
Date
16 Sept 2026
DKAType 1 diabetesICU
Chief Complaint
Vomiting and stomach pain, very thirsty for 2 days
Clinical Case
age
19 years
sex
F
occupation
University student
Vomiting and stomach pain, very thirsty
Duration
2 days
History of Present Illness
onset
Gradual
associated symptoms
- Polyuria
- Polydipsia
- Abdominal pain
- Drowsiness
Current Medications
- Insulin glargine 20 units nightly (missed 3 days)
- Insulin aspart with meals
medical
Type 1 diabetes since age 11; one prior DKA admission
vitals
BP
95/60
HR
118
RR
28
TEMP
37.2
SPO2
99%
general
Kussmaul breathing, dry mucous membranes, ketotic breath
weight
52 kg
labs
- Glucose 486 mg/dLOn arrival
- VBG: pH 7.08, HCO₃ 8 mmol/LOn arrival
- Serum ketones 5.8 mmol/LOn arrival
- pH 7.31, HCO₃ 17 mmol/L12 hours
primary diagnosis
Severe diabetic ketoacidosis
differentials
- Acute pancreatitis
- Sepsis
medications
- Normal saline1 L over 1 hour, then per protocolHour 0
- Fixed-rate IV insulin0.1 units/kg/hourHour 1
- Potassium chloride40 mmol/L in fluidsHour 2
referrals
- Diabetes specialist nurse
follow up
Endocrine clinic in 4 weeks; sick-day rules education