Question

Which of the following is true in ketoacidosis?

• A. Decreased HCO3
• B. Increased levels of lactate
• C. Glucose level < 250 mg/dl
• D. Normal anion gap

Hint:

Ketoacids consume bicarbonate and widen the anion gap; lactate belongs to lactic acidosis.

Answer 1

The Correct Option is A

Step 1: Define the disorder. Ketoacidosis, typically diabetic ketoacidosis, is a high anion gap metabolic acidosis caused by accumulation of ketoacids (acetoacetate and beta-hydroxybutyrate).
Step 2: Apply the buffering principle. The excess hydrogen ions from the ketoacids are buffered by bicarbonate, which is consumed in the process. Therefore serum bicarbonate (HCO3) falls. This makes option A true.
Step 3: Examine the anion gap. Because unmeasured ketoanions accumulate, the anion gap is increased, not normal. This makes option D false.
Step 4: Examine lactate. Raised lactate is the hallmark of lactic acidosis, a different cause of high anion gap acidosis; it is not the defining feature of ketoacidosis. This makes option B false.
Step 5: Examine glucose. In classic diabetic ketoacidosis the glucose is typically well above 250 mg/dl, so a value below 250 mg/dl is not the rule. This makes option C false.
Conclusion: The correct answer is option A, decreased HCO3.