This patient presents with hyperglycemia and symptoms concerning for DKA. Differential diagnosis includes other metabolic causes of hyperglycemia such as HHS, worsened diabetes or medication noncompliance. Considered possible causes of DKA to include infection (pancreatitis, UTI, pneumonia), infarction / ischemia (acute coronary syndrome, cerebral vascular accident), medication non-compliance with insulin therapy, illicit substance abuse, iatrogenic (including prescription medications and drug-drug interactions), idiopathic causes. Most likely etiology at this time is ***. Plan to treat the hyperglycemia as below while simultaneously evaluating and treating potential underlying etiologies.

Plan: POC glucose monitoring (Q1H), BMP (Q2H), blood gas, UA, serum ketones, CBC, LFTs / lipase, infectious workup (lactate/blood cultures, CHEST X-RAY)***, IVF, IV Insulin therapy, serial reassessment, admission for treatment of hyperglycemia