An unconscious adolescent with type 1 diabetes presents with a blood glucose level of 742 mg/dL. Which finding would you expect on initial assessment?

• A. Pyrexia
• B. Hyperpnea
• C. Bradycardia
• D. Hypertension

Answer: (B)

When type 1 diabetes goes into diabetic ketoacidosis, the body develops metabolic acidosis from ketone buildup. To compensate, the lungs drive ventilation up to blow off CO2, producing rapid, deep, labored breathing known as Kussmaul respiration. So an unconscious adolescent with very high blood glucose would most likely show hyperpnea as the initial finding.

Fever isn’t a defining sign of DKA and can point to infection rather than the acid-base disturbance itself. Bradycardia is unlikely; dehydration and electrolyte changes in DKA typically cause tachycardia. Hypertension is also not typical in this scenario, where dehydration and acidosis more often contribute to lower or normal blood pressure.