INS and metabolic acidosis: The presence of severe metabolic acidosis (as evidenced by arterial blood gas results), ketosis (characterized by significantly elevated blood β-HB, glucosuria, and ketonuria), and the absence of hyperglycemia collectively fulfilled the diagnostic criteria for EDKA.[1,2] Immediate treatment was initiated, including fluid resuscitation, 5% glucose infusion supplemented with potassium chloride and insulin, and continuous intravenous insulin administration via syringe pump.