In diabetic ketoacidosis, the high anion gap metabolic acidosis is due to accumulation of which molecules?

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Study for the NBME Form 13 Test with our comprehensive quiz collection, featuring flashcards and multiple-choice questions to ensure your readiness. Enhance your knowledge with detailed explanations for each question.

Multiple Choice

In diabetic ketoacidosis, the high anion gap metabolic acidosis is due to accumulation of which molecules?

Explanation:
The high anion gap metabolic acidosis in diabetic ketoacidosis comes from accumulation of ketone bodies produced by the liver when insulin is deficient. The two main ketone bodies are beta-hydroxybutyrate and acetoacetate. These organic acids dissociate in solution, increasing unmeasured anions and lowering bicarbonate, which raises the anion gap. Lactic acid can contribute if there’s poor perfusion, but the primary driver in classic DKA is ketone body buildup. Pyruvate and citrate aren’t the main sources of the extra anions in this setting.

The high anion gap metabolic acidosis in diabetic ketoacidosis comes from accumulation of ketone bodies produced by the liver when insulin is deficient. The two main ketone bodies are beta-hydroxybutyrate and acetoacetate. These organic acids dissociate in solution, increasing unmeasured anions and lowering bicarbonate, which raises the anion gap. Lactic acid can contribute if there’s poor perfusion, but the primary driver in classic DKA is ketone body buildup. Pyruvate and citrate aren’t the main sources of the extra anions in this setting.

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