Which combination of findings best characterizes diabetic ketoacidosis?

• A. Hyperglycemia, metabolic acidosis with anion gap, ketonemia.
• B. Normal glucose with metabolic acidosis.
• C. Hyperglycemia with metabolic alkalosis.
• D. Hypoglycemia with ketosis.

Answer: (A)

Diabetic ketoacidosis is defined by a triad: high blood glucose, an acid-base disturbance that is anion-gap metabolic acidosis, and the presence of ketone bodies (ketonemia). The lack of insulin plus elevated counter-regulatory hormones drives the liver to produce glucose (helping cause hyperglycemia) and to break down fats into fatty acids that are converted into ketone bodies. Those ketones accumulate in the blood, lowering pH and bicarbonate and creating an increased anion gap acidosis. The combination of hyperglycemia, anion-gap metabolic acidosis, and ketosis best fits the picture of DKA.

If glucose were normal, the metabolic acidosis could stem from other causes like lactic or toxin-related acidosis, not DKA. Metabolic alkalosis would be the opposite acid-base disturbance, not DKA. Hypoglycemia with ketosis can occur in fasting states or other conditions but does not match the hallmark hyperglycemia and ketosis pattern seen in DKA.