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Correct answer is B.
This patient is most likely suffering from diabetic ketoacidosis whereby insulin deficiency causes a state of uncontrolled metabolism as the body perceives low energy stores. Increased glycogen breakdown from the liver and reduced muscle uptake of glucose causes hyperglycaemia and excess ketones. The hyperglycaemia results in an osmotic diuresis and dehydration which in severe cases can cause renal hypoperfusion. Excess ketones cause a metabolic acidosis and are often discernible as excreted acetones in exhaled breath as a sweet odour. The resultant nausea and vomiting further the degree of dehydration and electrolyte loss. sweet 16 court wears

Pancreatitis (A) is most often characterized by severe pain in the epigastric or umbilical region of the abdomen with radiation towards the back. Nausea and vomiting can cause dehydration but ketone production is not a feature in an acute presentation.

Acute porphyria (C) occurs due to errors of inborn metabolism with a broad range of potential manifestations which are loosely divided into neurovisceral and photosensitive. Diffuse abdominal pain is a common feature with precipitants such as stress or alcohol intake, but there is no uncontrolled catabolic state causing excess ketones or hyperglycaemia.

Although liver failure (D) can also result in a musty sweet odour, this patient is very young with none of the other peripheral stigmata of liver disease such as gynaecomastia, jaundice and abdominal distension, among others.

Maple syrup urine disease (E) is a metabolic abnormality that affects branched chain amino acids resulting in a toxic accumulation of amino acids such as valine and leucine. The disorder primarily affects infants and young children with characteristically sweet smelling urine similar to the odour from maple syrup.