What key laboratory abnormalities characterize diabetic ketoacidosis?

• A. Hyperglycemia, metabolic acidosis with high anion gap, positive ketones, dehydration
• B. Hypoglycemia, metabolic alkalosis, negative ketones, dehydration
• C. Normal glucose, respiratory alkalosis, negative ketones, dehydration
• D. Hyperosmolar hyperglycemia without acidosis

Answer: (A)

In diabetic ketoacidosis, the lab picture reflects insulin deficiency with rising counterregulatory hormones, leading to three hallmark findings. First, glucose climbs because the liver overproduces glucose and tissues don’t take up it up effectively. Second, ketone bodies build up from increased fatty acid breakdown, producing a metabolic acidosis with a wide anion gap. Third, dehydration occurs from osmotic diuresis caused by the high glucose pulling water into the urine, along with ongoing fluid and electrolyte losses. The combination of high glucose, anion-gap metabolic acidosis due to ketones, and positive ketones in blood or urine, along with dehydration, best captures the typical lab abnormalities of DKA. This distinguishes it from other states like hyperosmolar hyperglycemic state, where glucose can be very high but ketones and acidosis are minimal.