What could MOST likely explain a woman with type I diabetes presenting deep, rapid breathing and altered mental status?

The presence of deep, rapid breathing and altered mental status in a woman with type I diabetes is most likely indicative of diabetic ketoacidosis (DKA), a serious condition that can occur when insulin is not administered properly. In this case, when a person with type I diabetes has not taken their insulin for several days, the body begins to break down fat instead of glucose for energy. This process leads to the production of ketones, which can accumulate in the blood, causing metabolic acidosis and significantly affecting the body’s pH balance.

The symptoms associated with DKA often include rapid and deep breathing (known as Kussmaul respiration) as the body attempts to offset the acidosis by expelling carbon dioxide. Additionally, altered mental status may occur due to variations in blood glucose levels or as a result of the acidosis itself affecting cerebral function. Thus, not taking insulin for several days aligns well with the presentation of these symptoms, making it the most plausible explanation in this scenario.

Other potential causes, such as low blood sugar or an infection leading to dehydration, could certainly present with various symptoms, but they do not specifically match the classic signs and symptoms associated with DKA as clearly as the lack of insulin does.