MRCP2-0697

MRCP2-0697

A 35-year-old homeless woman presents to the Emergency Department. Six hours previously, she had been seen in her usual state.
On admission, she has a Glasgow Coma Scale (GCS) score of 5, is afebrile, pulse 90 bpm, blood pressure 70/40 mmHg and RR 20/min. Her pupils are dilated and unreactive. Her fundi have blurred disc edges, and her breath smells sweet.
Investigations reveal the following:

Urinalysis ketones +
Glucose 2.5 mmol/l 3.5–5.5 mmol/l
Lactate 3.5 mmol/l 0.5–2.2 mmol/l
Plasma osmolar gap 30
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 3.0 mmol/l 3.5–5.0 mmol/l
Urea 8.0 mmol/l 2.5–6.5 mmol/l
Creatinine (Cr) 200 μmol/l 50–120 µmol/l
Chloride (Cl-) 106 mmol/l 98–106 mmol/l
Bicarbonate (HCO32-) 15 mmol/l 24–30 mmol/l
Corrected calcium (Ca2+) 2.30 mmol/l 2.20–2.60 mmol/l
Prothrombin time (PT) 12.9 s 10.6–14.9 s
Salicylate Not detected
Arterial blood gas (ABG) pa(O2) 12.5 kPa, pa(CO2) 2.5 kPa
What is the most likely diagnosis?