A 35-year-old man with type 1 diabetes presents with abdominal pain, vomiting, deep rapid breathing; blood glucose is 22 mmol/L and ketones are present in urine. What is the most appropriate diagnosis?

• A. Hyperglycemic hyperosmolar state
• B. Ketoacidosis
• C. Lactic acidosis
• D. Hypoglycemia

Answer: (B)

This presentation is classic for diabetic ketoacidosis in a person with type 1 diabetes. Hyperglycemia with ketones in the urine shows insulin deficiency driving lipolysis and ketone production, creating an anion-gap metabolic acidosis. The deep, rapid breathing is the body’s way of compensating for this acidosis (Kussmaul respiration). Abdominal pain and vomiting are common symptoms in DKA as well, reflecting the metabolic disturbance.

Hyperglycemic hyperosmolar state typically occurs in type 2 diabetes and features very high glucose with little or no ketosis and minimal acidosis; lactic acidosis would involve elevated lactate rather than prominent ketosis; hypoglycemia would present with low glucose. Thus the combination of high glucose, ketones, and acidosis markers points to diabetic ketoacidosis.