A 16-year-old girl with diabetes mellitus type 1 (T1DM) was presented to the emergency department with abdominal pain, nausea, and vomiting. In the past three days, her insulin dose was reduced as she had vomiting, diarrhea, and was unable to eat.

The patient’s physical examination revealed dry mucous membranes, poor skin turgor, and the fruity breath smells.