{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T09:39:14Z","timestamp":1773567554380,"version":"3.50.1"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"7-8","license":[{"start":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T00:00:00Z","timestamp":1662681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Diabetic ketoacidosis (DKA) is a serious disease entity that must be diagnosed quickly for urgent management in the intensive care unit. Keeping DKA in the differential diagnosis is important, especially in a forward deployed, resource-poor setting. The symptoms and signs of DKA are nonspecific, including fatigue, polydipsia, polyuria, weakness, weight loss, nausea, vomiting, and abdominal pain with tachycardia and tachypnea on exam. The testing capability to evaluate for DKA includes a glucometer, urine dipstick, and basal metabolic panel, all of which can be done in most forward deployed settings. The need for a high index of suspicion for DKA in patients with these symptoms is required due to the lack of life-saving insulin and intensive lab monitoring required. The downstream effects of DKA include diabetic coma and death. We present a case report of a 21-year-old otherwise healthy, active duty, male Marine who presents to the clinic with a chief complaint of 4\u00a0days of headache and 1\u00a0day of nausea with four episodes of non-bloody, non-bilious emesis along with epigastric abdominal pain. He returned to the clinic 2\u00a0days later with evidence of tachycardia and increased work of breathing, at which time there was a concern for a pulmonary embolus. By the time he was transferred to the emergency room, he was in severe DKA. The patient was treated in the intensive care unit and made a full recovery. He was processed for limited duty and medical board upon hospital discharge.<\/jats:p>","DOI":"10.1093\/milmed\/usac266","type":"journal-article","created":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T21:42:18Z","timestamp":1662759738000},"page":"e2809-e2811","source":"Crossref","is-referenced-by-count":1,"title":["Presentation of Severe Diabetic Ketoacidosis in New-Onset Type One Diabetes Mellitus: The Importance of a Broad Differential in an Otherwise Healthy Population in the Operational Environment"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6572-9853","authenticated-orcid":false,"given":"Emily M","family":"Makhlouf","sequence":"first","affiliation":[{"name":"Branch Medical Clinic Futenma, United States Naval Hospital Okinawa , Okinawa, AP 96362, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,9,9]]},"reference":[{"key":"2023072301105202300_R1","article-title":"Incidence of newly diagnosed diabetes","author":"Centers for Disease Control and Prevention"},{"issue":"3","key":"2023072301105202300_R2","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.mcna.2016.12.011","article-title":"Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"101","author":"Fayfman","year":"2017","journal-title":"Med Clin North Am"},{"key":"2023072301105202300_R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107797","article-title":"Defining and characterising diabetic ketoacidosis in adults","volume":"155","author":"Dhatariya","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"issue":"11","key":"2023072301105202300_R4","doi-asserted-by":"publisher","first-page":"2449","DOI":"10.2337\/dc21-0770","article-title":"Adult-onset type 1 diabetes: current understanding and challenges","volume":"44","author":"Leslie","year":"2021","journal-title":"Diabetes Care"},{"key":"2023072301105202300_R5","article-title":"2020 Demographics: profile of the military community","author":"Department of Defense, Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy (ODASD (MC&FP))"},{"issue":"2","key":"2023072301105202300_R6","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/j.jpeds.2012.06.058","article-title":"Diabetic ketoacidosis at diabetes onset: still an all too common threat in youth","volume":"162","author":"Klingensmith","year":"2013","journal-title":"J Pediatr"},{"issue":"4","key":"2023072301105202300_R7","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1542\/peds.2013-2795","article-title":"Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study","volume":"133","author":"Dabelea","year":"2014","journal-title":"Pediatrics"},{"issue":"12","key":"2023072301105202300_R8","doi-asserted-by":"publisher","first-page":"362","DOI":"10.15585\/mmwr.mm6712a3","article-title":"Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality \u2013 United States, 2000\u20132014","volume":"67","author":"Benoit","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"2023072301105202300_R9","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1053\/jcrc.2002.33030","article-title":"Abdominal pain in patients with hyperglycemic crises","volume":"17","author":"Umpierrez","year":"2002","journal-title":"J Crit Care"},{"issue":"suppl 1","key":"2023072301105202300_R10","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.2007.S109","article-title":"Hyperglycemic Crises in Patients With Diabetes Mellitus","volume":"26","author":"American Diabetes Association","year":"2003","journal-title":"Diabetes Care"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/7-8\/e2809\/50937522\/usac266.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/7-8\/e2809\/50937522\/usac266.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,23]],"date-time":"2023-07-23T01:16:45Z","timestamp":1690075005000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/7-8\/e2809\/6694807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,9]]},"references-count":10,"journal-issue":{"issue":"7-8","published-online":{"date-parts":[[2022,9,9]]},"published-print":{"date-parts":[[2023,7,22]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usac266","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7,1]]},"published":{"date-parts":[[2022,9,9]]}}}