Ketones are elevated in DKA but not in HHS.

Ketones are elevated in DKA but not in HHS.

• A. Ketones are elevated in both DKA and HHS.
• B. Ketones are elevated in HHS only.
• C. Ketones are not formed in DKA.
• D. Ketones are elevated in DKA but not in HHS.

Answer: (D)

Ketone production hinges on insulin status. In diabetic ketoacidosis, a severe lack of insulin allows large amounts of fatty acids to be released and shunted into the liver, where they’re converted into ketone bodies. Those ketones accumulate in the blood, causing metabolic acidosis and a high ketone level. In hyperosmolar hyperglycemic state, there’s usually enough insulin to suppress lipolysis and ketogenesis, so ketones are not significantly elevated despite very high glucose and dehydration. Thus, the typical teaching is that ketones are elevated in DKA but not in HHS. (Rarely, mild ketosis can occur in HHS with extreme stress or dehydration, but it is not the norm.)

Ketone production hinges on insulin status. In diabetic ketoacidosis, a severe lack of insulin allows large amounts of fatty acids to be released and shunted into the liver, where they’re converted into ketone bodies. Those ketones accumulate in the blood, causing metabolic acidosis and a high ketone level. In hyperosmolar hyperglycemic state, there’s usually enough insulin to suppress lipolysis and ketogenesis, so ketones are not significantly elevated despite very high glucose and dehydration. Thus, the typical teaching is that ketones are elevated in DKA but not in HHS. (Rarely, mild ketosis can occur in HHS with extreme stress or dehydration, but it is not the norm.)