DKA signs beyond hyperglycemia?

• A. Hypokalemia
• B. Hyperkalemia with normal anion gap
• C. Ketosis, high anion gap metabolic acidosis, dehydration, Kussmaul respiration
• D. Excess insulin levels

Answer: (C)

The key idea is recognizing what DKA adds to hyperglycemia: production of ketones and a resulting high anion gap metabolic acidosis, with dehydration and a compensatory breathing pattern. In DKA, lack of insulin drives fat breakdown and ketone formation, so ketosis appears alongside elevated glucose. Those ketones create an acid burden, causing a high anion gap metabolic acidosis. The acidosis and osmotic diuresis contribute to dehydration, and the body attempts to blow off CO2 with rapid, deep breathing known as Kussmaul respiration. Potassium balance in DKA is tricky: total body potassium is depleted even if serum potassium may be high or normal early on, so hypokalemia isn’t the defining sign. Hyperkalemia with a normal anion gap doesn’t fit because the acidosis in DKA usually contributes to a high anion gap; excess insulin levels are not characteristic, since DKA reflects insulin deficiency, not excess.