What is the recommended monitoring for lipolysis and ketone production in DKA?

• A. Check serum ketones and β-hydroxybutyrate; track anion gap and bicarbonate
• B. Monitor only blood glucose
• C. Check C-peptide
• D. Measure lactate alone

Answer: (A)

In DKA, the level of lipolysis and ketone production is best assessed by directly monitoring the ketone burden and the resulting acid-base disturbance. Measuring serum ketones, specifically beta-hydroxybutyrate, gives a clear picture of ongoing ketogenesis, which drives the metabolic acidosis in DKA. At the same time, tracking the anion gap and bicarbonate level shows how severe the acidosis is and how it’s resolving with treatment. Beta-hydroxybutyrate is often the dominant ketone in DKA, so its measurement provides a more accurate read on ketosis than other ketone forms alone. As insulin and fluids are given and lipolysis drops, beta-hydroxybutyrate decreases and the anion gap closes with bicarbonate rising toward normal, signaling recovery. Monitoring glucose is important for treatment decisions, but it doesn’t tell you about ongoing ketone production, so it shouldn’t be the sole parameter. C-peptide reflects endogenous insulin production rather than acute ketone production, and lactate alone doesn’t capture the ketotic state in DKA.