An unconscious 16-year-old with type 1 diabetes has a blood glucose level of 742 mg/dL. Which finding is expected during the initial assessment?

An unconscious 16-year-old with type 1 diabetes has a blood glucose level of 742 mg/dL. Which finding is expected during the initial assessment?

• A. Pyrexia
• B. Hyperpnea
• C. Bradycardia
• D. Hypertension

Answer: (B)

In this scenario the key idea is diabetic ketoacidosis from insulin deficiency. The high glucose and metabolic derangement lead to metabolic acidosis as ketones accumulate. To try to correct the pH, the body drives ventilation up, producing rapid, deep, labored breathing known as hyperpnea or Kussmaul respiration. That breathing pattern is the classic finding you’d expect on initial assessment. Fever isn’t a typical feature of DKA and suggests infection, though that could coexist. Bradycardia isn’t expected; dehydration and acidosis usually cause tachycardia. Hypertension is unlikely with volume depletion often seen in DKA. So the most likely initial finding is rapid, deep breathing as the body compensates for metabolic acidosis.

In this scenario the key idea is diabetic ketoacidosis from insulin deficiency. The high glucose and metabolic derangement lead to metabolic acidosis as ketones accumulate. To try to correct the pH, the body drives ventilation up, producing rapid, deep, labored breathing known as hyperpnea or Kussmaul respiration. That breathing pattern is the classic finding you’d expect on initial assessment.

Fever isn’t a typical feature of DKA and suggests infection, though that could coexist. Bradycardia isn’t expected; dehydration and acidosis usually cause tachycardia. Hypertension is unlikely with volume depletion often seen in DKA. So the most likely initial finding is rapid, deep breathing as the body compensates for metabolic acidosis.