A 57 year old lady presents unwell with abdominal pain and vomiting.

Her blood results show:Severe HAGMA = AG 26

Partial compensation, expected CO2 = 19

additional NAGMA = hyperchloraemia

Delta ratio – 0.8

Mild elevation in glucose

High ketones

normal Creatinine

Severe DKA with relative normoglycaemia or hypoglycaemia – occurs in setting of SGLT II inhibitors (Jaridamet is a combination of Metformin and SGLT II inhibitor).

Abdominal pain – likely due to DKA but exclude abdominal causes

Treat as per DKA protocol