A marker of ketoacidosis
Characterize the symptom (onset, pace)
Ask the patient:
Do you have diabetes? Are you taking steroids? Is this a new or worsening symptom? When did it start or get worse? Has the symptom developed gradually or suddenly? How strong is the odor?
Note: More sudden onset would be suggestive of an endocrinopathy.
Ask the patient:
Do you have excessive thirst? Have you had any frequent urination; nausea and vomiting; abdominal (belly) pain; weakness; tremor, shortness of breath; or confusion?”
For patients with known diabetes:
Ask what their blood sugar level is and whether they have checked urine ketones.
Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?