title: Failure to diagnose: diabetic ketoacidosis.
abstract: A recent coronial inquest examined the death of a patient, 17 years of age, from fulminant diabetic ketoacidosis.1 The patient's presentation with diabetic ketoacidosis was the first manifestation of the onset of type 1 diabetes. This article examines the Coroner's findings and recommendations.
authors.affiliation: Medico-Legal and Advisory Services, MDA National, Australia. sbird@mdanational.com.au
authors.forename: Sara
authors.initials: S
authors.lastname: Bird
mesh_terms: D000293:Adolescent; D001315:Australia; D001344:Autopsy; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000473:pathology; D003951:Diagnostic Errors / Q000331:legislation & jurisprudence*; D017809:Fatal Outcome; D005260:Female; D058005:General Practitioners / Q000331:legislation & jurisprudence*; D006801:Humans; D016365:Liability, Legal; D008318:Malpractice / Q000331:legislation & jurisprudence; D018908:Muscle Weakness; D011141:Polyuria; D018570:Risk Assessment; D014839:Vomiting