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[ Sixth , determine] the presence of any associated GI symptoms Nausea Abdominal pain [Abdominal] distension Diarrhea Obstipation [Seventh,] infectious symptoms should be elicited, including: Fever, Dysuria, Ear pain, Cough, Coryza, Shortness of breath Meningismus [ Eighth , consider the possibility of diabetic ketoacidosis, DKA:] Source: PMID: PMID: 25941653 The clinical signs of DKA include dehydration (may be difficult to detect), tachycardia, tachypnoea (may be mistaken for pneumonia or asthma), deep sighing (Kussmaul) respiration with a typical smell of ketones in the breath (variously described as the odor of nail polish remover or rotten fruit), nausea, vomiting (may be mistaken for gastroenteritis), abdominal pain (may mimic an acute abdominal condition), confusion, drowsiness, progressive reduction in level of consciousness, and eventually loss of consciousness