R.ABDUL KARIM

CLINICAL CASE 🩺 A 19-year-old university student is brought to the emergency department with a 2-day history of vomiting, abdominal pain and progressive weakness. His mother reports that over the past three weeks, he has been unusually thirsty, passing urine frequently and losing weight despite eating normally. On examination: - He appears severely dehydrated. - Temperature: 37.2°C - BP: 94/60 mmHg - Pulse: 124 bpm - Respiratory rate: 32 breaths/min, deep and laboured. - GCS: 14/15 - His breath has a characteristic fruity smell. - His mucous membranes are dry and his eyes appear sunken. Investigations: - Random blood glucose: 28 mmol/L - Blood ketones: 5.8 mmol/L - Arterial pH: 7.12 - Serum bicarbonate: 8 mmol/L - Serum potassium: 5.2 mmol/L He is haemodynamically compromised, severely dehydrated and showing features of significant metabolic acidosis. QUESTIONS: 1. What is the single most likely diagnosis? 2. Explain the mechanism behind his deep, laboured breathing. 3. Outline your immediate management priorities. You are the doctor receiving this patient. What is your first move?