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:
In diabetic ketoacidosis, lack of insulin and elevated counterregulatory hormones drive fat breakdown and hepatic ketogenesis, leading to the accumulation of ketone bodies that are acids—primarily beta-hydroxybutyrate and acetoacetate. As these ketone bodies build up, they release hydrogen ions and deplete bicarbonate, creating a high anion gap metabolic acidosis. The unmeasured anions responsible for the gap are these ketone bodies, making them the main contributors in this condition. While lactic acid can cause acidosis in poor perfusion, it’s not the primary driver in classic DKA. Pyruvate and formic acid aren’t the key culprits here.

In diabetic ketoacidosis, lack of insulin and elevated counterregulatory hormones drive fat breakdown and hepatic ketogenesis, leading to the accumulation of ketone bodies that are acids—primarily beta-hydroxybutyrate and acetoacetate. As these ketone bodies build up, they release hydrogen ions and deplete bicarbonate, creating a high anion gap metabolic acidosis. The unmeasured anions responsible for the gap are these ketone bodies, making them the main contributors in this condition. While lactic acid can cause acidosis in poor perfusion, it’s not the primary driver in classic DKA. Pyruvate and formic acid aren’t the key culprits here.

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