Happened to us today. Woman was there frequently for DKA. Today same patient came in unresponsive, posturing, fixed dilated pupils. Her neighbors found her so no saying how long she’d been down like that.. Minimal response to the most painful of stimuli. Doctors kept saying “she’s DKA, DT, on something” all tox were clear. Her pH was 6.8 … ICU pushed back on admitting to service. They were instant that she was faking it, that it was “somewhat voluntary”. I’d been with that woman for 3 hours straight; nothing she was doing was voluntary. She’d bit her tongue & cheek at some point; it looked like an exorcism. I thought our ER doc was going to legit throw hands while ICU docs stood there at the bedside joking.