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The acute presentation may include weakness, fruity breath, nausea, vomiting with coffee-ground content, dehydration, and altered sensorium.[] The investigations specific for DKA include HbA1c, estimation of urine and serum ketone bodies, assessing the effective serum osmolality (mOsm/kg) and anion gap (mEq/L)

doi: 10.1186/1741-7015-11-63

Common reasons extrapolated from review of the medical records included ongoing treatment with VPA and reported symptoms suggestive of HA, given that the majority of the patients were on treatment with VPA (66% of both HA and non-HA groups) and 37% reported symptoms at the time of testing