Medical Emergencies · patient case question
Diabetic ketoacidosis is characterised by all of the following EXCEPT:
Patient case: Emergencies and risk assessment
demo: Assorted patients
chief: Several patients present with findings that alter the safety of planned dental care.
history: One patient with well-controlled asthma using albuterol reports her last attack was ten months ago. Another feels faint on being returned to upright. A third has type 1 diabetes and presents unwell with deep rapid breathing and a fruity breath odour.
meds: Albuterol; insulin; various.
findings: Not applicable.
Show answer and explanation
Correct answer: D. Metabolic alkalosis
- A. Ketosis is definitional. Absolute insulin deficiency drives lipolysis and hepatic ketogenesis, producing acetoacetate, beta-hydroxybutyrate and acetone, the last of which gives the fruity breath.
- B. Gluconeogenesis is accelerated. Without insulin, the unopposed action of glucagon, cortisol and catecholamines drives hepatic glucose production upward and worsens the hyperglycaemia.
- C. Hyperglycaemia is present, typically above 250 mg per dL, causing osmotic diuresis and profound dehydration.
- D. Correct, and this is the exception. DKA produces a metabolic ACIDOSIS, not alkalosis. Accumulating ketoacids consume bicarbonate and drive the pH down, and the body compensates with Kussmaul respiration, the deep rapid breathing that blows off carbon dioxide.
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