Diabetic ketoacidosis is characterized by all of the following EXCEPT:

Correct answer: B. Decreased gluconeogenesis

• A. Metabolic acidosis with an elevated anion gap is the defining feature, produced by accumulation of beta-hydroxybutyrate and acetoacetate.
• B. CORRECT — this is the EXCEPT. Gluconeogenesis is markedly INCREASED in DKA, not decreased. Absolute insulin deficiency with unopposed glucagon drives hepatic gluconeogenesis and glycogenolysis, which is a major contributor to the severe hyperglycemia.
• C. Hyperglycemia, typically above 250 mg/dL, is one of the three diagnostic criteria.
• D. Ketosis follows from unrestrained lipolysis and hepatic fatty acid oxidation when insulin is absent.

Note: The DKA triad: hyperglycemia, ketosis, metabolic acidosis. Clinically look for Kussmaul respiration (deep, laboured compensatory breathing), acetone breath, dehydration, abdominal pain and altered mental status. It is a medical emergency — activate EMS.