A 14-year old boy who is known to have type 1 diabetes is admitted to hospital with a history of nausea, vomiting and abdominal pain over the previous 24 hours. On examination he is dehydrated and drowsy. The following results are obtained:
Serum: sodium 130 mmol/L [135-145]
potassium 5.8 mmol/L [3.6-5.0]
bicarbonate 5 mmol/L [22-30]
urea 18 mmol/L [3.3-5.0]
creatinine 136 µmol/L [55-120]
Plasma: glucose 30 mmol/L
Urine: strongly positive for glucose and ketones