NREMT Emergency Medical Technician (EMT) Cognitive ExamMedical EmergenciesMedium
A 16-year-old female is found by her parents in her bedroom, confused and disoriented. She has a history of Type 1 diabetes. Her breath has a fruity odor, and her respirations are deep and rapid. Her blood glucose level is 'HIGH' on the glucometer. What is the MOST likely cause of her altered mental status?
- AInsulin shock.
- BHyperosmolar hyperglycemic state (HHS).
- CHypoglycemia.
- DDiabetic ketoacidosis (DKA).
Show answer & explanationAnswer & explanation
Correct answer: D. Diabetic ketoacidosis (DKA).
The patient's symptoms (altered mental status, history of Type 1 diabetes, fruity breath odor, deep and rapid respirations (Kussmaul's respirations), and high blood glucose) are classic for diabetic ketoacidosis (DKA). DKA is a severe complication of diabetes characterized by hyperglycemia, metabolic acidosis, and ketone production.
Why the other options are wrong
- A. Insulin shock is another term for severe hypoglycemia, which is inconsistent with the high blood glucose and other symptoms.
- B. HHS typically occurs in Type 2 diabetics, involves extremely high blood glucose, and severe dehydration, but usually lacks the fruity breath and Kussmaul's respirations of DKA.
- C. Hypoglycemia would present with low blood glucose and typically cool/clammy skin, not fruity breath or deep/rapid respirations.
Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is a life-threatening complication of Type 1 diabetes (and sometimes Type 2), characterized by hyperglycemia, metabolic acidosis, and ketone production, often triggered by infection, illness, or missed insulin doses.
- Symptoms include altered mental status, polyuria, polydipsia, polyphagia, nausea/vomiting.
- Classic signs are fruity breath odor (from ketones) and Kussmaul's respirations (deep, rapid breathing to blow off CO2).
- Blood glucose is typically very high (>250 mg/dL).
- Requires aggressive fluid resuscitation and insulin therapy.
Memory trick: High sugar, fruity breath, fast breathing? DKA is the reason!