The symptoms of an episode of<unk>  usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. In severe<unk> , breathing becomes rapid and of a deep, gasping character, called "Kussmaul breathing". The abdomen may be tender to the point that a serious abdominal condition may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Vomiting altered blood that resembles coffee grounds occurs in a minority of people and tends to originate from erosion of the esophagus. In severe<unk> , there may be confusion or a marked decrease in alertness, including coma. On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, a rapid heart rate and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity" or like "pear drops". The smell is due to the presence of acetone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate. Small children with<unk>  are relatively prone to brain swelling, also called cerebral edema, which may cause headache, coma, loss of the pupillary light reflex, and can progress to death. It occurs in about 1 out of 100 children with<unk>  and more rarely occurs in adults.
Diabetic ketoacidosis
Hyperosmolar hyperglycemic state
Alcoholic ketoacidosis
Uremia
Serkal syndrome
Hypovolemic shock
Salicylate poisoning
Diabetic hypoglycemia