NBME Step 2 CK Form 8 Diabetic ketoacidosis (NBME Answers)

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Adolescent with history of weight loss despite normal appetite presents with acute nausea, vomiting, abdominal pain, mental status changes and is found to be dry on physican exam with labs consistent with an anion-gap metabolic acidosis (135 – 101 – 14 = 20 > 12) with an elevated glucose, most consistent with diabetic ketoacidosis
DKA: Glucose 250-500, anion-gap metabolic acidosis, ketones in urine, GI symptoms predominate
Hyperosmolar hyperglycemic state: Glucose > 600, relatively normal acid-base status, no ketones in urine, altered mental status predominates

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cbreland Knowing that it is an AG met. acidosis allows you to narrow options to ethylene glycol/methanol ingestion and DKA. Time frame of a month of weight loss and dry membranes with 250 glucose more consistent with DKA. +1