CHEST SEEK® Author Commentary (7 New Flashcards! June 2026)-Diabetic Ketoacidosis Nongap Acidosis - Commentary From Steven Q. Simpson, MD, FCCP

Diabetic Ketoacidosis Nongap Acidosis - Commentary From Steven Q. Simpson, MD, FCCP

Video Transcription

Video Summary

A professor explains a confusing DKA question: after initial treatment, a patient may develop a normal anion gap metabolic acidosis. The key reason is not ongoing ketones, but loss of ketones in urine that could have been converted back to bicarbonate. Large amounts of saline also add chloride, replacing the lost anions and causing hyperchloremic acidosis. He describes ketone metabolism, bicarbonate consumption, and why balanced fluids like lactated Ringer’s can reduce this problem during DKA resuscitation.

Asset Caption

This question is found in the Renal, Endocrine, and Metabolism Disorders module in the Critical Care Medicine Collection.

Keywords

diabetic ketoacidosis

normal anion gap metabolic acidosis

hyperchloremic acidosis

ketone loss in urine

lactated Ringer's