A 27 year old man presents to the Emergency Department with decreased conscious level. He has a past medical history of type 1 diabetes mellitus. On examination, his airway is patent, respiratory rate is 24 breaths per minute, SpO2 94% on room air, breath sounds are vesicular with no added sounds, he has cool peripheries and GCS of 11 (E2V4M5).
A venous blood gas is taken; this reveals pH 7.27, PCO2 3.0kPa, HCO3 14 mmol/L, lactate 1.7 mmol/L. Blood glucose is 27.9 mmol/L. Blood ketones is 4mmol/L.