Which presentation might indicate diabetic ketoacidosis (DKA)?

The presentation indicating diabetic ketoacidosis (DKA) is characterized by polyuria, high blood glucose levels, and the presence of fruity breath, which is specifically due to the accumulation of acetone in the blood as a result of fat metabolism. In DKA, the body lacks sufficient insulin, which leads to excessive breakdown of fatty acids for energy, producing ketones as a byproduct. The fruity breath, often described as having a "sweet" smell, stems from these ketones, particularly acetone. Additionally, polyuria occurs due to osmotic diuresis caused by the high levels of glucose in the urine. This symptom quartet—high blood glucose, polyuria, and fruity breath—is classic for DKA and allows for prompt recognition and intervention in patients who might be struggling with uncontrolled diabetes.

Other options do not align with the typical presentation of DKA. For example, blood glucose levels below 300 with no ketones can indicate well-controlled diabetes or another condition but do not meet the criteria for DKA. A gradual onset of hypoglycemia with confusion suggests a different problem, possibly insulin overdose or inappropriate medication management, while elevated blood pressure with dehydration may suggest other conditions such as hyperosmolar hyperglycemic state, but lacks