Diabetic Ketoacidosis Case 3

You are handed over a 20-year-old lady with known type one diabetes who has been feeling generally unwell for the last two days with a cough, green sputum and shortness of breath.

On examination airway is patent, respiratory rate is 38 breaths per minute, oxygen saturations are 98% on 10L of oxygen, bronchial breathing left lower posterior aspect of the thorax, pulse 130 beats per minute, blood pressure 90/45 mmHg, GCS E4V4M5. Temperature recorded at 39.5 degrees Celsius.

What is your initial treatment? (Select all that apply).

The chest x-ray comes back and you note extensive consolidation in the left lower lobe. You decide to do an ABG to measure the lactate and ensure that you are administering the correct amount of oxygen. The ABG is as follows;

You go to see another patient. You are called back in an hour, as the patient is now unresponsive.

What are the three most likely causes?