What is the hallmark of diabetic ketoacidosis (DKA)?

The hallmark of diabetic ketoacidosis (DKA) is characterized by hyperglycemia, metabolic acidosis, and ketonuria. In DKA, patients typically present with significantly elevated blood glucose levels, often exceeding 250 mg/dL. This hyperglycemia leads to osmotic diuresis, resulting in dehydration and electrolyte imbalances.

Metabolic acidosis occurs due to the accumulation of ketone bodies, which are produced when fat is used as an alternative energy source due to insufficient insulin. The presence of ketones in the urine, also known as ketonuria, is another key feature of DKA, indicating that the body is in a state of ketosis.

Together, these components—hyperglycemia, metabolic acidosis, and ketonuria—are essential for diagnosing DKA and differentiating it from other hyperglycemic emergencies, such as hyperglycemic hyperosmolar state (HHS), where acidosis and ketonuria are typically absent. This combination highlights the metabolic derangements that occur in the acute setting of DKA, making it a central aspect of this life-threatening condition.