Which ketone bodies are elevated in diabetic ketoacidosis and how are they detected?

• A. Acetoacetate and beta-hydroxybutyrate; detected by serum ketone meters or nitroprusside testing of urine samples.
• B. Acetoacetate only; detected by breath acetone measurement.
• C. Beta-hydroxybutyrate only; detected by plasma glucose meter.
• D. Acetoacetate and acetone; detected by lactate dehydrogenase assay.

Answer: (A)

In diabetic ketoacidosis, the body shifts to producing a lot of ketone bodies because insulin is low and fat breakdown is increased. The two main ketones that rise are acetoacetate and beta-hydroxybutyrate, with acetone being a volatile byproduct that can contribute to fruity breath.

For detection, different tests pick up different ketones: serum ketone meters measure beta-hydroxybutyrate, which is often the predominant circulating ketone in DKA, giving a good sense of ketone load. The nitroprusside-based urine test detects acetoacetate (and acetone) but not beta-hydroxybutyrate, so it captures another major ketone that’s elevated. Breath acetone testing exists but isn’t a standard clinical measure, and a plasma glucose meter or a lactate dehydrogenase assay do not assess ketone levels.

So the correct idea is that acetoacetate and beta-hydroxybutyrate are elevated, and they are detected by serum ketone meters or nitroprusside testing of urine samples.