MSFinals-1032

A 16-year-old boy with an 8-year history of type I diabetes presents to the Emergency Department (ED) with a 24-hour history of vomiting. He tested his glucose and ketones at home and they were both high, glucose 30 mmol/L, ketones 3 mmol/L, so he attended the ED. He admits to omitting his insulin frequently. He appears dehydrated, has ketotic fetor, BP 112/76 mmHg, pulse 108 beats per minute, temp 37 degrees, oxygen saturations 98% on room air. Clinical examination is otherwise normal. The following are his laboratory investigations:
Test Result Normal range
pH 7.2 7.35–7.45
Ketones 3 mmol/l < 0.6 mmol/l
Glucose 28 mmol/l 3.5–5.5 mmol/l
Bicarbonate 11 mmol/l 24–30 mmol/l
Base excess -5 mEq/l −2 to +2 mEq/l
C-reactive protein (CRP) 3 mg/l 0–10 mg/l
What is required to make a diagnosis of diabetic ketoacidosis in this patient?