an 18-year-old male high school student who had a 4-year historyof diabetes mellitus was brought ... Question: An 18-year-old malehigh school student who had a 4-year history of diabetes mellituswas brought... An 18-year-old male high school student who had a4-year history of diabetes mellitus was brought to the emergencydepartment because of excessive drowsiness, vomiting, and diarrhea.His diabetes had been well controlled with 40 units of NPH insulindaily until several days ago when he developed excessive thirst andpolyuria. For the past 3 days, he has also had headaches, myalgia,and a low-grade fever. Diarrhea and vomiting began 1 day ago.URINALYSIS RESULTS and CHEMISTRY TEST RESULTS
Specific gravity 1.012 Sodium 126 mmol/L
pH 5.0 Potassium 6.1 mmol/L
Glucose 4+ Chloride 87 mmol/L
Ketone Large Bicarbonate 6 mmol/L
Plasma glucose 600 mg/dL
BUN 48 mg/dL
Creatinine 2.0 mg/dL
Serum ketones 4+
Questions 1. What is the probable diagnosis of this patientbased on the data presented?
2. What laboratory test(s) should be performed to follow thispatient and aid in adjusting insulin levels?
3. Why are the urine ketones positive?
4. What methods are used to quantitate urine ketones? Whichketone(s) do they detect?
