Question

Which of the following is responsible for increase in anion gap during diabetic ketosis?

• A. Increase in lipolysis leading to increase in ketone bodies
• B. Loss of water and electrolytes
• C. Decrease in concentration of bicarbonate ions
• D. Accumulation of hydrogen ions with decrease in pH

Hint:

Mnemonic for high anion gap metabolic acidosis: "MUDPILES" (Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Infection/Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates).

Answer 1

The Correct Option is A

Step 1: Understanding the Concept:
The anion gap is a diagnostic calculation used to evaluate acid-base disorders, calculated as: \[ \text{Anion Gap} = [Na^+] - ([Cl^-] + [HCO_3^-]) \]
An elevated anion gap indicates the presence of unmeasured anions in the plasma, which replace bicarbonate as it is consumed during buffering.

Step 2: Detailed Explanation:
In diabetic ketosis, a lack of effective insulin leads to unregulated lipolysis in adipose tissue.
This lipolysis releases large quantities of free fatty acids into the bloodstream, which are transported to the liver.
In the liver, these fatty acids undergo \(\beta\)-oxidation and are converted into the ketone bodies acetoacetate and \(\beta\)-hydroxybutyrate.
These ketone bodies dissociate into hydrogen ions (\(H^+\)) and ketoanions (acetoacetate and \(\beta\)-hydroxybutyrate).
The free hydrogen ions are buffered by bicarbonate (\(HCO_3^-\)), causing its concentration to decrease.
The corresponding ketoanions remain in the plasma as unmeasured anions.
Because these ketoanions are not accounted for in the standard measurement of chloride and bicarbonate, their accumulation directly increases the calculated anion gap.
Thus, the primary process responsible for this elevation is the increase in lipolysis that leads to the accumulation of these ketone bodies.

Step 3: Final Answer:
The process responsible for the increase in the anion gap during diabetic ketosis is the increase in lipolysis leading to an increase in ketone bodies.