On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, a rapid heart rate and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity" or like "pear drops". The smell is due to the presence of acetone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.