What acid-base disturbance characterizes diabetic ketoacidosis?

• A. Anion-gap metabolic acidosis with ketosis
• B. Non-anion gap metabolic acidosis
• C. Metabolic alkalosis
• D. Hyperchloremic acidosis

Answer: (A)

In diabetic ketoacidosis the body cannot use insulin and fat breakdown accelerates, producing ketone bodies (like acetoacetate and beta-hydroxybutyrate) that are acids. These ketoacids accumulate and consume bicarbonate, creating a high anion gap metabolic acidosis while ketosis is present, which is the hallmark of DKA. The other patterns don’t fit: a non-anion gap acidosis lacks the elevated anion gap; metabolic alkalosis has too much base (high bicarbonate); hyperchloremic acidosis is a normal anion gap acidosis often seen after bicarbonate loss or excessive chloride, not the primary picture in DKA.