Which lab finding is consistent with diabetic ketoacidosis?

• A. Metabolic alkalosis with hypoglycemia
• B. Respiratory alkalosis with hyperglycemia
• C. Normal acid-base status
• D. Metabolic acidosis with hyperglycemia and ketonemia

Answer: (D)

When diabetic ketoacidosis develops, insulin deficiency with elevated counterregulatory hormones drives rapid lipolysis and hepatic production of ketone bodies. Those ketones are acids, so the blood becomes acidotic, producing a metabolic acidosis. At the same time, impaired glucose uptake and increased glucose production cause marked hyperglycemia. The presence of both high glucose and ketones with acidosis (often an elevated anion gap) is the hallmark, and the body may compensate with faster breathing to blow off CO2.

So the lab pattern you’d expect is metabolic acidosis with hyperglycemia and ketonemia. The other patterns don’t fit this picture: metabolic alkalosis would require a high pH and bicarbonate; a primary respiratory alkalosis wouldn’t align with the acid-base derangement driven by ketone production; normal acid-base status would miss the acidosis and ketones; and hypoglycemia isn’t typical of DKA.