Medical Emergencies · single question
A patient with poorly controlled diabetes develops metabolic acidosis. What is the most likely mechanism?
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Correct answer: B. Ketoacidosis from insulin deficiency
- A. Decreased bicarbonate reabsorption causes a hyperchloremic metabolic acidosis (e.g., renal tubular acidosis), not the anion-gap acidosis of DKA.
- B. In uncontrolled Type 1 (or severe Type 2) diabetes, insulin deficiency causes lipolysis → ketone body production (beta-hydroxybutyrate, acetoacetate) → metabolic acidosis (DKA). This is the classic mechanism of diabetes-related metabolic acidosis. ✓
- C. Carbon dioxide retention causes respiratory acidosis, not metabolic acidosis. This is seen in COPD, not diabetes.
- D. Lactic acidosis can occur in DM, especially with metformin or tissue hypoperfusion, but it is not the primary mechanism of diabetic metabolic acidosis.
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