Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email Customer Success ( for more information.


After completing this case study, the reader should be able to:

  • Recognize signs and symptoms of diabetic ketoacidosis (DKA).

  • Determine laboratory parameters for the diagnosis and monitoring of DKA.

  • Identify anticipated fluid and electrolyte abnormalities associated with DKA and their treatment.

  • Recommend appropriate insulin therapy for treating DKA.

  • Identify therapeutic decision points in DKA treatment and provide parameters for altering therapy at those points.


Chief Complaint

“I felt weak and nauseated during softball practice. I checked my blood glucose and it read ‘HI’ (blood glucose >600 mg/dL).”


A 21-year-old woman with a history of type 1 diabetes diagnosed 3 years ago is a college senior at the local university where she also plays softball. She started using an insulin pump approximately 6 months ago.

She noticed she was unusually tired and short of breath at the beginning of her practice and then began feeling weak and nauseated. She was also very thirsty during practice. Her softball coach said she seemed “a little confused.” He advised her to check her blood glucose, and it read “HI”. She checked her insulin pump and noticed the pump had become disconnected. She is unsure how long she has been without insulin. She vomited two times since shortly thereafter and was transported via EMS to the ED.


Type 1 DM diagnosed 3 years ago. No prior hospitalizations for DKA or prior surgeries.


Parents are alive and healthy. One twin sister who also has type 1 DM.


College student; no tobacco, alcohol, or illicit drug use. Sexually active; in a monogamous relationship.


NovoLog 100 U/mL, per insulin pump

Basal rates:

  • 0.6 U/hr 0000–0300

  • 0.9 U/hr 0300–0700

  • 0.8 U/hr 0700–1100

  • 0.7 U/hr 1100–1730

  • 0.8 U/hr 1730–0000

Correction factor: 1 U:40 mg/dL >120 mg/dL

Insulin:carbohydrate ratios:

  • 1:10 insulin:carbohydrate before breakfast

  • 1:15 insulin:carbohydrate before lunch and dinner

Glucagon injection kit, as needed

Sprintec (35 mcg ethinyl estradiol/0.25 mg norgestimate) one tablet PO once daily × 3 years




Complains of blurry vision, lethargy, shortness of breath, nausea, polyuria, and polydipsia. Denies constipation, diarrhea, and headache.

Physical Examination


WDWN woman appearing her stated age, with deep ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.