SGPGI Nursing Officer-2022
Medical & Surgical Nursing
Medium
Which of the following signs would not be seen in diabetic ketoacidosis (DKA)?
Appeared in: SGPGI Nursing Officer-2022
Explanation
- Diabetic ketoacidosis (DKA) is a classic example of a high anion gap metabolic acidosis (HAGMA).
- The pathophysiology involves the overproduction of ketone bodies (acetoacetate and β-hydroxybutyrate), which are organic acids.
- These ketone bodies are 'unmeasured anions' that increase the calculated anion gap, typically to a value greater than 12 mEq/L.
- A low anion gap is the opposite of what is expected and would point away from a diagnosis of DKA.
Why Other Options Were Wrong
- Option A: Hyperglycemia (high blood sugar) is a cardinal feature of DKA. It results from severe insulin deficiency, which impairs glucose uptake by tissues and promotes excessive glucose production by the liver.
- Option C: A low bicarbonate level is expected in DKA. Bicarbonate (HCO₃⁻) is the body's primary chemical buffer, and it gets consumed in an attempt to neutralize the high levels of ketoacids.
- Option D: A fruity or acetone-like odor on the breath is a classic clinical sign of DKA. It is caused by the exhalation of acetone, a volatile ketone body produced during ketogenesis.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology and laboratory findings of Diabetic Ketoacidosis (DKA) as background academic context rather than a clinical decision trigger.
- Calculating the anion gap is a crucial step for nurses in interpreting lab results for a patient with suspected DKA. It helps confirm the diagnosis and differentiate it from other types of acidosis.
- During treatment for DKA, nurses monitor the anion gap along with glucose and bicarbonate levels. The 'closing' of the anion gap (its return to normal) is a key indicator that the metabolic acidosis is resolving and is often used as a criterion to transition from intravenous to subcutaneous insulin.
- What if? If a patient with diabetes presents with acidosis but has a normal anion gap, the nurse should suspect a different cause, such as severe diarrhea (leading to bicarbonate loss) or a renal tubular acidosis. This finding would prompt a different diagnostic and treatment pathway than for DKA.
How to Approach the Question
- First, identify that the question is a 'negative' question, asking what is NOT a sign of DKA. This means three of the options are correct signs, and one is incorrect.
- Recall the core pathophysiological features of DKA: Hyperglycemia, Ketosis, and Acidosis.
- Evaluate each option against these core features.
- A) Hyperglycaemia: This is a hallmark of DKA. This is a correct sign.
- C) Low bicarbonate: This is expected in metabolic acidosis as bicarbonate is used for buffering. This is a correct sign.
- D) Fruity odorous breath: This is a classic sign of ketosis (acetone on the breath). This is a correct sign.
Concept Tested & Keywords
- Concept Tested: Pathophysiology and laboratory findings of Diabetic Ketoacidosis (DKA)
- Stem keywords: diabetic ketoacidosis, DKA, signs
- Lead-in keywords: not
- Negative lead-in flag: Question asks for the finding NOT seen in DKA.
Question ID
QooK7N1JMxJq5GTbkFMWu-
Reference Book
E6 Medicine Davidson Principles Practice 24e p. 756-758
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 56-58
E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 1 (pp 26-370 of 370) p. 199-201
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