A school-age child with type 1 diabetes mellitus arrives to the emergency department with a heart rate of 145 bpm, blood pressure, of 86/52 mmHg, and fruity breath odor. The caregiver reports the child hasn't voided in the last 12 hours. Which complication does the nurse suspect?

A. Hyperglycemia without ketones: While hyperglycemia causes polyuria and dehydration, the presence of fruity breath odor strongly suggests ketone accumulation. The child’s hypotension and tachycardia also point to severe dehydration and acidosis, not simple hyperglycemia. B. Diabetic ketoacidosis (DKA): The combination of fruity breath odor, tachycardia, hypotension, and anuria indicates severe dehydration and ketone buildup. These findings are classic for DKA, which is a life-threatening complication of type 1 diabetes mellitus. C. Insulin overdose: Excess insulin would result in hypoglycemia, often with symptoms like tremors, sweating, and seizures. Hypotension and fruity breath odor would not be expected in this case, making overdose unlikely. D. Hypoglycemia with ketones: Hypoglycemia is not associated with ketone buildup, as ketones form in states of insulin deficiency with hyperglycemia. The clinical picture here aligns with hyperglycemia and ketosis, not low blood sugar.