Diabetic ketoacidosis in the pediatric population.

A 14-year-old boy with benign history is found unresponsive in his bedroom by his sister. There is vomit on his shirt. Thinking back, Mom remembers the patient drinking and urinating “a lot” in the past several weeks and thinks “his clothes hang off of him.” He has been home from school the past few days because of fatigue and malaise “and just not feeling well.” They called their doctor when he complained of some abdominal pain and were told, “It's the flu and will get better in a few days.” He has had no fever, rash, injury, or ingestion. His vital signs are as follows: Heart rate: 130Respiratory rate: 32Blood pressure: 90/65Temperature: 37° CWeight: 55 kgGeneral exam: somnolent but arousable, will open eyes on command, fruity odor on breathAirway: patent, no stridorBreathing: tachypneic, Kussmaul respirationsCirculation: clammy, cool skin, capillary refill 4 seconds, parched lips, sunken eyesAbdomen: mildly tender diffusely, no distention, BS × 4 quadrantsPupils: 3-4 mm b/lGlasgow Coma Score: 12-13Chem stix: “high”