Which statement is most characteristic of DKA regarding ketone presence?

• A. Elevated lactate with minimal ketone production.
• B. Normal ketone levels.
• C. Presence of ketones in serum or urine.
• D. Normal anion gap metabolic acidosis.

Answer: (C)

In DKA, insulin deficiency drives rapid fat breakdown and liver ketogenesis, so ketone bodies accumulate in the blood and are excreted in the urine. This ketonemia and ketonuria are characteristic features and explain the metabolic acidosis seen in DKA, which is typically high in anion gap due to ketoacids like acetoacetate and beta-hydroxybutyrate. While lactate can be elevated in stressful states, it’s the presence of ketones that cleanly marks DKA. Normal ketone levels would not fit the picture, and a normal anion gap acidosis isn’t typical because the acidosis in DKA is driven by ketoacids, not bicarbonate loss.