Which metabolic change characterizes diabetic ketoacidosis and leads to acidosis?

• A. Sodium bicarbonate accumulation in blood
• B. Ketone production from rapid fat breakdown
• C. Nitrogen accumulation from protein catabolism
• D. Excessive cholesterol deposition in tissues

Answer: (B)

In diabetic ketoacidosis, lack of insulin drives rapid fat breakdown and ketone production. When insulin is low, fat stores are mobilized and the liver converts the resulting free fatty acids into ketone bodies (acetoacetate and beta-hydroxybutyrate). These ketones are acidic, so their accumulation in the blood lowers pH and creates a metabolic acidosis, typically with a high anion gap. This ketone-driven acid load is the key change that leads to acidosis in DKA.

Sodium bicarbonate buildup would oppose acidosis, not cause it. Protein breakdown does occur, but it’s not the main source of the acid load in DKA. Cholesterol deposition is unrelated to the acute acid-base disturbance.