ABSTRACT
This chapter presents a case study of a 27-year-old man who is presented to the Emergency Department with a 1-day history of nausea, vomiting and feeling generally unwell. The patient has a history of type 1 diabetes and is on a 'basal-bolus' regime comprising of daily glargine and mealtime novorapid. The most important diagnosis to exclude in any patient with type 1 diabetes who is unwell is diabetic ketoacidosis (DKA), whereby insulin deficiency leads to impaired glucose utilisation by cells and the production of ketone bodies leading to a metabolic acidosis. DKA is a medical emergency and carries a low, but not insignificant, mortality risk. The initial evaluation of DKA includes measuring electrolytes, serum glucose and a venous blood gas. Patients with a low Glasgow Coma Scale (GCS) and who do not show immediate improvement with initial resuscitation should have a CT scan of the head to look for cerebral oedema.
