Diabetic ketoacidosis (DKA) is a critical state of hyperglycemia that results in both hyperketonemia and acidosis. Despite elevated serum glucose in DKA, the cells are “starving” due to the lack of insulin to facilitate glucose uptake. Therefore, fatty acids are utilized, which produce ketones and an anion gap ketoacidosis.

Hyperglycemia causes glucose to spill into the urine, resulting in an osmotic diuresis that leads to dehydration and electrolyte derangements. The acidosis causes K+ to shift out of cells, leading to serum hyperkalemia. K+ and bicarbonate are lost in the urine, depleting whole body potassium. The loss of bicarbonate further exacerbates the acidosis.