In diabetic ketoacidosis, which of the following combinations is typical?

• A. High glucose, anion gap metabolic acidosis, positive ketones, dehydration
• B. Low glucose, metabolic alkalosis
• C. Normal glucose, non-anion gap acidosis
• D. Hyperglycemia with high bicarbonate and no acidosis

Answer: (A)

In diabetic ketoacidosis, the body has a lack of insulin and an excess of counterregulatory hormones, which drives the liver to produce lots of glucose and ketone bodies. The result is marked high blood glucose (hyperglycemia) and a buildup of acidic ketones, leading to an anion gap metabolic acidosis. The ketones appear in the blood and urine (positive ketones), and the severe hyperglycemia causes osmotic diuresis, so the patient becomes dehydrated. This combination—high glucose, anion gap metabolic acidosis, positive ketones, and dehydration—is the typical picture of DKA.

The other scenarios don’t fit DKA. Low or normal glucose with acidosis, or alkalosis, doesn’t match the hyperglycemia and ketone-driven acidemia of DKA. Hyperglycemia with a high bicarbonate and no acidosis would contradict the characteristic acidosis of DKA.