Related Experiment Video
Updated: Jun 15, 2026
11:12
Hyperinsulinemic-Euglycemic Clamp in the Conscious Rat
Published on: February 7, 2011
Diabetic ketoacidosis presenting with a normal anion gap
G T Gamblin1, R W Ashburn, D G Kemp
1Endocrine Division, Naval Hospital, Portsmouth, Virginia, USA.
The American Journal of Medicine
|March 13, 2010
Summary
Diabetic ketoacidosis typically causes a wide anion gap metabolic acidosis. However, this case shows diabetic ketoacidosis can occur with a normal anion gap in non-insulin-dependent diabetes mellitus.
Area of Science:
- Endocrinology
- Nephrology
- Internal Medicine
Background:
- Diabetic ketoacidosis (DKA) is traditionally associated with a high anion gap metabolic acidosis due to ketoacid accumulation.
- Non-insulin-dependent diabetes mellitus (NIDDM) accounts for a significant portion of diabetes cases.
Observation:
- An NIDDM patient presented with hyperglycemia, ketonemia, and acidosis.
- The patient's acidosis exhibited a normal anion gap.
- No other causes for hyperchloremic metabolic acidosis were identified.
Findings:
- Resolution of acidosis occurred after intravenous insulin administration.
- This case challenges the assumption that a normal anion gap excludes DKA.
- DKA can manifest with a normal anion gap in specific NIDDM presentations.
Implications:
- Clinicians should consider DKA even with a normal anion gap in NIDDM patients.
- This finding may necessitate a re-evaluation of diagnostic criteria for DKA.
- Further research is needed to understand the mechanisms behind normal anion gap DKA.
![Assessment of Gastric Emptying in Non-obese Diabetic Mice Using a [13C]-octanoic Acid Breath Test](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F50301.jpg&w=3840&q=50)
Related Concept Videos
01:25Diabetic Ketoacidosis l: Introduction
DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic ketone production, and...
01:22Diabetic Ketoacidosis ll: Pathophysiology
Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...
01:24Diagnosing Acidosis and Alkalosis
Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and HCO3− values are examined to...
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and HCO3− values are examined to...
01:22Complications of Diabetes Mellitus
Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia due to insulin deficiency, resistance, or both. Prolonged hyperglycemia disrupts metabolic homeostasis and leads to acute and chronic complications.Acute ComplicationsAcute complications result from sudden metabolic imbalance.Diabetic ketoacidosis (DKA) mainly appears in type 1 diabetes but may also develop in type 2 diabetes, particularly under extreme stress. It arises from severe insulin deficiency,...
01:21Hyperosmolar Hyperglycemic State
Hyperosmolar Hyperglycemic State, or HHS, is a serious and life-threatening complication of type 2 diabetes mellitus. It is characterized by three main features: severe hyperglycemia, profound dehydration, and elevated serum osmolality, all occurring without significant ketoacidosis.HHS typically develops in older adults or individuals with limited access to fluids. This may result from illness, cognitive impairment, or medications such as diuretics or corticosteroids. These factors reduce...
01:28Diabetic Nephropathy
Definition Diabetic nephropathy is a chronic kidney complication that results from prolonged hyperglycemia.Prevalence It is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, affecting up to half of individuals with diabetes.Pathophysiology • Sustained hyperglycemia triggers multiple hemodynamic and metabolic changes in the kidney. • Early in the disease, increased renal blood flow and glomerular hyperfiltration occur due to afferent arteriolar...