A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 480 text mg/dL , text pH = 7.22, text HCO _3^- = 10 text mEq/L , and positive urine ketones. The calculated anion gap is: Na^+ = 138, Cl^- = 95, HCO_3^- = 10. What is the anion gap and what does it indicate?

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Nursing QUESTION #9232

Question 1

A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of \(480 \text{ mg/dL}\), \(\text{pH} = 7.22\), \(\text{HCO}_3^- = 10 \text{ mEq/L}\), and positive urine ketones. The calculated anion gap is: Na\(^+ = 138\), Cl\(^- = 95\), HCO\(_3^- = 10\). What is the anion gap and what does it indicate?

\(\text{AG} = 23 \text{ mEq/L}\) — normal anion gap acidosis
\(\text{AG} = 33 \text{ mEq/L}\) — high anion gap metabolic acidosis
\(\text{AG} = 43 \text{ mEq/L}\) — mixed disorder
\(\text{AG} = 13 \text{ mEq/L}\) — normal, not metabolic acidosis✔️

Correct Answer Explanation

Correct Answer: B — AG = 33 mEq/L, High anion gap metabolic acidosis

Anion Gap Formula:
\[\text{AG} = \text{Na}^+ - (\text{Cl}^- + \text{HCO}_3^-)\]
\[\text{AG} = 138 - (95 + 10) = 138 - 105 = 33 \text{ mEq/L}\]

Normal AG: \(8 - 12 \text{ mEq/L}\) (with albumin correction if hypoalbuminaemia)

High AG causes (MUDPILES mnemonic):

Methanol
Uraemia (renal failure)
DKA / alcoholic ketoacidosis
Propylene glycol / Paraldehyde
Isoniazid / Iron
Lactic acidosis
Ethylene glycol
Salicylates

DKA produces ketoacids (acetoacetate, beta-hydroxybutyrate) — unmeasured anions that widen the AG. Treatment: IV fluids, insulin infusion, potassium replacement.

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