Diabetic Ketoacidosis: beware hidden dangers

A 52 year old man presented with confusion. He was febrile with evidence of circulatory compromise and delirium. He was known to have type 2 diabetes mellitus of more than 10 years duration and had been prescribed insulin for more than 5 years. At the time of admission severe diabetic ketoacidosis was diagnosed and a treatment with intravenous fluids, insulin and broad spectrum antibiotics was commenced (Table). Despite aggressive treatment, the patient remained delirious with raised inflammatory markers.