An 18-year-old male high school

An 18-year-old male high school

student who had a 4-year history of a

diabetes mellitus was brought to the

emergency department because of

excessive drowsiness, vomiting, and

diarrhea. His diabetes had been well

controlled with 40 units of NPH

insulin daily until several days ago

when he developed excessive thirst

and polyuria. For the past 3 days, he 3

has also had headaches, myalgia,

and a low-grade fever. Diarrhea and

vomiting began 1 day ago.

QUESTION:

1. What is the probable diagnosis of

this patient based on the data

presented?

2. What laboratory test(s) should be

performed to follow this patient and

aid in adjusting insulin levels?

3. Why are the urine ketones

positive?

4. What methods are used to

quantitate urine ketones? Which

ketone(s) do they detect?