Questionnaire/history: Known diabetes? Blood glucose > 11 mmol/L? Increased thirst and urinary frequency? Weight loss? Inability to tolerate fluids? Persistent vomiting and/or diarrhoea? Abdominal pain? Visual disturbance? Lethargy and/or confusion? Fruity smell of acetone on the breath? Acidotic breathing — deep sighing (Kussmaul) respiration? Moderate dehydration (dry skin and mucus membranes, and reduced skin turgor)? Severe dehydration (sunken eyes and prolonged CRT)? Shock? - Tachycardia? - Prolonged CRT? - Lethargy/drowsiness/decreased level of consciousness? - Reduced urine output? Precipitating factors? - Infection - Physiological stress (eg trauma or surgery)? - Non-adherence to insulin treatment regimen? - Intentional insulin omission in order to lose weight (diabulimia)? Past medical history? Family history? Current medication? Drug allergies? Investigations: Ketonuria > 2+ on standard urine strip? Ketonaemia > 3 mmol/L? (Note: Consider the possibility of DKA in all people with type 1 diabetes who are unwell; hyperglycaemia may not always be present.) Diagnosis: Suspected DKA Management: Emergency admission for fluid resuscitation and IV insulin Reference(s): NICE CKS: When should I suspect diabetic ketoacidosis in a person with type 1 diabetes?