ABSTRACT
Vomiting and abdominal pain are common presenting symptoms in patients who are acutely ill. Such individuals may be referred to physicians, surgeons, and even gynaecologists, as there are so many causes of vomiting and abdominal pain. Diabetic Ketoacidosis (DKA) should be considered in any unwell diabetic patient, particularly those who are short of breath but not hypoxaemic. The symptoms and signs follow from the pathophysiological processes. Thus, DKA presents with nausea, vomiting and abdominal pain (a central effect of ketosis); signs of dehydration (from the vomiting and osmotic diuresis); hyperventilation. The stress of illness often increases insulin requirement. It is important that patients are properly educated to avoid serious complications. The diabetes services within individual trusts often produce information regarding the use of supplemental insulin for patients with intercurrent illness and high blood glucose. Increasing the dose of insulin can avoid progression to DKA, however patients have different basal insulin requirements and ideally should have an individualised schedule.
