In diabetic ketoacidosis, which electrolyte abnormality is commonly seen?

• A. Normal anion gap metabolic acidosis.
• B. Metabolic alkalosis.
• C. Respiratory alkalosis.
• D. Elevated anion gap metabolic acidosis with low bicarbonate.

Answer: (D)

Ketoacidosis in diabetes drives production of ketoacids that accumulate in the blood. These unmeasured anions raise the anion gap, and the increased hydrogen ions are buffered by bicarbonate, which falls as buffering occurs. The result is an elevated anion gap metabolic acidosis with low bicarbonate—the central acid-base disturbance in diabetic ketoacidosis. Other patterns like normal‑anion‑gap acidosis or alkalosis do not fit this scenario. (For completeness, serum potassium may be high initially, but total body potassium is usually depleted due to diuresis and losses.)