In diabetic ketoacidosis, excessive hepatic ketone body production causes a high anion gap metabolic acidosis. Using the anion gap formula AG = [Na^+] - ([Cl^-] + [HCO_3^-]), which finding is expected?

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MBBS QUESTION #10354

Question 1

In diabetic ketoacidosis, excessive hepatic ketone body production causes a high anion gap metabolic acidosis. Using the anion gap formula $AG = [Na^+] - ([Cl^-] + [HCO_3^-])$, which finding is expected?

An elevated anion gap, due to accumulation of unmeasured ketoacid anions (acetoacetate and beta-hydroxybutyrate)✔️
A normal anion gap accompanied by hyperchloremia
A decreased anion gap below the normal reference range
No change in anion gap despite the fall in blood pH

Correct Answer Explanation

Ketoacid anions (acetoacetate, beta-hydroxybutyrate) are not accounted for in the standard anion gap formula, so their accumulation raises the calculated gap — producing a characteristic high anion gap metabolic acidosis, distinguishing DKA from normal anion gap (hyperchloremic) causes of acidosis such as diarrhea or renal tubular acidosis.

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