How to check sugar? Recently, a patient with severe diabetic ketoacidosis was admitted and is now in stable condition and ready to be discharged from the hospital. The patient had been seen for abdominal pain for half a month and had been transferred to three tertiary hospitals in Nanjing, involving gastroenterology, emergency medicine and general surgery, but the abdominal pain was not relieved and was finally controlled in endocrinology. Why did so many major hospitals and specialties specializing in abdominal pain fail to detect and effectively treat diabetic ketoacidosis? It is due to the special way of starting diabetic ketoacidosis. Newly-onset diabetic patients may not know the typical symptoms of diabetes mellitus, cannot provide the doctor with typical dry mouth, polyphagia, polyphagia, polyuria, wasting and do not provide the above medical history or have atypical symptoms, so the doctor misses to check the blood sugar without knowing, and under the stimulation of high blood sugar, the fool develops painful neuropathy causing abdominal pain, although other tests are normal, antibacterial and anti-inflammatory, protecting the gastric mucosa, the patient’s symptoms are still gradually aggravated, and by the time the patient reaches our department, the patient is already severely dehydrated. The patient was severely dehydrated and acidotic, and when we asked about his medical history, the patient was dry-mouthed, drank a lot, ate a lot, urinated a lot, lost weight for more than a month, and lost more than 50 pounds! How to recognize diabetic ketoacidosis? Diabetic ketoacidosis is a common acute complication of diabetes mellitus, and its main triggers are mainly infection, improper diet or treatment and various stress factors. Clinical manifestations of ketoacidosis include the following: 1. worsening of diabetic symptoms 2. worsening of symptoms of polydipsia and polyuria, physical strength and weight loss 3, gastrointestinal symptoms 4, including decreased appetite, nausea and vomiting, diarrhea, some patients have abdominal pain. 5, respiratory changes Respiratory increase, some patients may have a ketone odor similar to the smell of rotten apples in the breath. 6.Dehydration and shock symptoms Patients with moderate or severe ketoacidosis often have symptoms of dehydration, and those with dehydration up to 5% may have dehydration, such as reduced urine volume, dry skin and sunken eyes. If dehydration exceeds 15% of body weight, circulatory failure may occur, with symptoms including rapid heart rate, weak pulse, decreased blood pressure and body temperature, etc. Serious cases may be life-threatening. The clinical manifestations of mental changes vary greatly among individuals. Early on, there are headache, dizziness, depression followed by irritability, drowsiness and coma. The causes of coma include excessive acetoacetic acid, cerebral hypoxia, dehydration, elevated plasma osmolality and circulatory failure. Uropathy ketoacidosis? The examination indicates elevated blood glucose, mostly in the range of 16.7 to 33.3 mmol/L, sometimes up to 33.3 to 55.5 mmol/L; positive urine sugar, strong positive urine ketone bodies, when combined with renal dysfunction, ketone bodies can not be excreted by the urine, so although ketoacidosis occurs, but the urine ketone bodies negative or only trace; elevated blood ketones, blood ketones are measured mostly by the nitroprusside method, currently it is more recognized that blood ketones <0.6 mmol/L is normal, and blood ketones >5 mmol/L has diagnostic significance. Blood gas analysis indicates a decrease in blood carbon dioxide binding capacity and pH, and a decrease in residual base level with a significantly higher anion gap. Blood electrolytes and urea nitrogen (BUN) tests indicate that sodium and chloride are often low due to blood concentration and can be normal or elevated; blood potassium can be normal, low or high. However, the overall potassium, sodium and chloride are reduced and BUN is increased, which is due to the decrease of blood volume, insufficient renal perfusion and increased protein decomposition. Other tests may include: (1) Blood tests Granulocyte and neutrophil levels may be increased in response to blood concentration, infection or enhanced adrenocortical function. (2) Urine routine There may be signs of urinary tract infection. (3) Blood lipids may be elevated, and in severe cases, the serum may be chylomicronous. (4) Chest X-ray It is useful to find the triggering or secondary diseases. (5), electrocardiogram It is useful to find the trigger (such as myocardial infarction) It can help to understand the blood potassium level. So, for patients with abdominal pain, think about whether you may have the next typical symptoms of diabetes, especially those with a family history of diabetes should be concerned about diabetes.