Which of the following is NOT a typical finding in diabetic ketoacidosis?

• A. High anion gap metabolic acidosis with positive ketones
• B. Normal anion gap metabolic acidosis
• C. Kussmaul respirations
• D. Hyperglycemia with plasma glucose >250 mg/dL

Answer: (B)

In diabetic ketoacidosis, the body's lack of insulin leads to increased ketone production, causing a high anion gap metabolic acidosis from the accumulation of unmeasured anions (ketone bodies). You also see marked hyperglycemia (usually above 250 mg/dL) and a compensatory, deep, rapid breathing pattern called Kussmaul respiration to blow off CO2. A normal anion gap metabolic acidosis is not typical in DKA; that pattern comes from bicarbonate loss without increased unmeasured anions (as in diarrheal losses or certain renal tubular disorders). So the finding that is NOT typical is normal anion gap metabolic acidosis.