Ketoacidosis MCQs With Answer

Ketoacidosis MCQs With Answer

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Ketoacidosis MCQs With Answer is a focused resource tailored for B. Pharm students to master diabetic ketoacidosis (DKA) and related ketoacidotic states. This concise, SEO-friendly introduction covers pathophysiology, clinical features, laboratory diagnosis (anion gap, ABG, ketone assays), pharmacotherapy (insulin protocols, electrolytes), and complications such as cerebral edema and euglycemic DKA from SGLT2 inhibitors. Emphasis on applied pharmacology, fluid and electrolyte management, and monitoring helps pharmacy graduates counsel patients and support clinical teams. The content balances core science with practical drug-related decisions, making it ideal for exam preparation and clinical practice. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary metabolic disturbance in diabetic ketoacidosis (DKA)?

  • Excessive insulin action
  • Accumulation of ketoacids due to insulin deficiency
  • Primary respiratory alkalosis
  • Excessive sodium retention

Correct Answer: Accumulation of ketoacids due to insulin deficiency

Q2. Which ketone body predominates in classic DKA?

  • Acetoacetate
  • Acetone
  • Beta-hydroxybutyrate
  • Pyruvate

Correct Answer: Beta-hydroxybutyrate

Q3. Which laboratory criteria are commonly used to diagnose DKA? (Choose the best single set)

  • Plasma glucose <70 mg/dL, pH <7.0, HCO3 >24 mEq/L
  • Hyperglycemia, metabolic acidosis (pH <7.3), elevated ketones
  • Normal glucose, respiratory acidosis, negative ketones
  • Hypoglycemia, metabolic alkalosis, positive ketones

Correct Answer: Hyperglycemia, metabolic acidosis (pH <7.3), elevated ketones

Q4. Which anion gap value suggests the presence of an elevated anion gap metabolic acidosis typical of DKA?

  • Anion gap <8 mEq/L
  • Anion gap 8–10 mEq/L
  • Anion gap >12 mEq/L
  • Anion gap exactly 0 mEq/L

Correct Answer: Anion gap >12 mEq/L

Q5. The nitroprusside (nitroferricyanide) urine ketone test primarily detects which ketone?

  • Beta-hydroxybutyrate
  • Acetoacetate
  • Acetone
  • Beta-hydroxybutyrate and acetone equally

Correct Answer: Acetoacetate

Q6. In DKA, total body potassium is usually:

  • Normal despite hyperkalemia in serum
  • Increased with cellular potassium accumulation
  • Depleted despite normal or elevated serum potassium
  • Unaffected by insulin deficiency

Correct Answer: Depleted despite normal or elevated serum potassium

Q7. Initial fluid of choice for resuscitation in most DKA protocols is:

  • 0.45% NaCl (half-normal saline)
  • Lactated Ringer’s solution exclusively
  • 0.9% NaCl (normal saline)
  • 5% dextrose in water

Correct Answer: 0.9% NaCl (normal saline)

Q8. A common initial IV insulin regimen for adult DKA includes:

  • No insulin; give oral agents only
  • Insulin glargine subcutaneously once
  • Regular insulin 0.1 U/kg bolus then 0.1 U/kg/hr infusion
  • Immediate NPH insulin injection

Correct Answer: Regular insulin 0.1 U/kg bolus then 0.1 U/kg/hr infusion

Q9. When plasma glucose reaches about 200 mg/dL during treatment, recommended action is:

  • Stop all fluids and insulin immediately
  • Add dextrose to IV fluids to avoid hypoglycemia while continuing insulin
  • Increase insulin infusion rate twofold
  • Switch to subcutaneous rapid-acting insulin without overlap

Correct Answer: Add dextrose to IV fluids to avoid hypoglycemia while continuing insulin

Q10. Which electrolyte should be closely monitored and often replaced during DKA treatment?

  • Calcium
  • Potassium
  • Magnesium
  • Zinc

Correct Answer: Potassium

Q11. Indication for giving IV bicarbonate in DKA is generally limited to:

  • All DKA patients routinely
  • Severe acidosis with pH <6.9
  • When serum sodium is high
  • When serum glucose >500 mg/dL

Correct Answer: Severe acidosis with pH <6.9

Q12. Euglycemic DKA is most commonly associated with which drug class?

  • Sulfonylureas
  • SGLT2 inhibitors
  • Thiazolidinediones
  • Alpha-glucosidase inhibitors

Correct Answer: SGLT2 inhibitors

Q13. Which statement about arterial vs venous pH in DKA is correct?

  • Venous pH is typically 0.03–0.05 units lower than arterial pH
  • Venous pH is interchangeable with arterial pH with predictable difference and acceptable for monitoring
  • Only arterial pH can detect acidosis
  • Venous pH is usually much higher than arterial pH in DKA

Correct Answer: Venous pH is interchangeable with arterial pH with predictable difference and acceptable for monitoring

Q14. The primary mechanism causing metabolic acidosis in DKA is:

  • Accumulation of lactic acid due to hypoperfusion
  • Ketone body accumulation from increased lipolysis and hepatic ketogenesis
  • Excessive bicarbonate loss via kidneys
  • Respiratory failure causing CO2 retention

Correct Answer: Ketone body accumulation from increased lipolysis and hepatic ketogenesis

Q15. Which ketone assay best reflects current severity of ketoacidosis?

  • Urine nitroprusside test
  • Blood beta-hydroxybutyrate measurement
  • Breath acetone test only
  • Serum acetoacetate by dipstick

Correct Answer: Blood beta-hydroxybutyrate measurement

Q16. In DKA, serum sodium typically appears low; how should sodium be corrected for hyperglycemia?

  • Corrected Na = measured Na + 1.6 mEq/L per 100 mg/dL glucose over 100 mg/dL
  • Do not correct sodium; measured value is accurate
  • Corrected Na = measured Na – 5 mEq/L per 100 mg/dL glucose
  • Sodium correction is done only when glucose <100 mg/dL

Correct Answer: Corrected Na = measured Na + 1.6 mEq/L per 100 mg/dL glucose over 100 mg/dL

Q17. Which complication is a particular concern in pediatric DKA during rapid fluid correction?

  • Cerebral edema
  • Acute pancreatitis
  • Deep vein thrombosis
  • Myocardial infarction

Correct Answer: Cerebral edema

Q18. The delta anion gap to delta bicarbonate ratio helps evaluate mixed acid-base disorders. A delta/delta ratio >2 suggests:

  • Pure high anion gap metabolic acidosis
  • Concurrent metabolic alkalosis
  • Concurrent normal anion gap metabolic acidosis
  • Mixed high anion gap metabolic acidosis and metabolic alkalosis

Correct Answer: Mixed high anion gap metabolic acidosis and metabolic alkalosis

Q19. Alcoholic ketoacidosis (AKA) differs from DKA by usually presenting with:

  • Very high blood glucose >300 mg/dL
  • History of chronic alcohol use and low or normal glucose with ketosis
  • Positive SGLT2 inhibitor use
  • Marked hyperinsulinemia

Correct Answer: History of chronic alcohol use and low or normal glucose with ketosis

Q20. Which of the following best describes the role of insulin in DKA treatment?

  • Insulin only lowers glucose but does not affect ketone production
  • Insulin reduces hepatic ketogenesis and shifts potassium into cells
  • Insulin increases lipolysis and worsening ketogenesis
  • Insulin is contraindicated until pH normalizes

Correct Answer: Insulin reduces hepatic ketogenesis and shifts potassium into cells

Q21. Which IV fluid change is recommended when the corrected serum sodium is normal or high after initial saline resuscitation?

  • Continue isotonic saline indefinitely
  • Switch to 0.45% NaCl (half-normal saline)
  • Switch to 3% hypertonic saline
  • Start 5% dextrose only

Correct Answer: Switch to 0.45% NaCl (half-normal saline)

Q22. Which laboratory pattern is typical in severe DKA regarding phosphate?

  • Total body phosphate depletion despite normal or low serum phosphate
  • Marked hyperphosphatemia due to impaired renal excretion
  • No change in phosphate balance
  • Always high serum phosphate needing urgent removal

Correct Answer: Total body phosphate depletion despite normal or low serum phosphate

Q23. In DKA, when should potassium replacement be withheld initially?

  • If serum K+ <3.3 mEq/L
  • If serum K+ is >5.5 mEq/L
  • If patient received insulin bolus
  • Potassium should never be withheld

Correct Answer: If serum K+ is >5.5 mEq/L

Q24. Which clinical feature is most characteristic of DKA?

  • Hypoventilation
  • Kussmaul respirations (deep rapid breathing)
  • Bradycardia
  • Painless jaundice

Correct Answer: Kussmaul respirations (deep rapid breathing)

Q25. The presence of an elevated anion gap with normal osmolar gap suggests:

  • Toxic alcohol ingestion as the only cause
  • An endogenous metabolic acidosis like DKA is likely
  • Pure respiratory acidosis
  • Hyperosmolar hyperglycemic state without ketosis

Correct Answer: An endogenous metabolic acidosis like DKA is likely

Q26. Which insulin formulation is preferred for IV infusion in DKA management?

  • Regular insulin (short-acting)
  • Insulin glargine
  • Insulin detemir
  • Premixed NPH/regular insulin

Correct Answer: Regular insulin (short-acting)

Q27. During DKA therapy, frequent monitoring should include:

  • Blood glucose every 1–2 hours and electrolytes every 2–4 hours
  • Electrolytes only once daily
  • Glucose only on admission
  • No monitoring is necessary after starting insulin

Correct Answer: Blood glucose every 1–2 hours and electrolytes every 2–4 hours

Q28. Which acid–base parameter indicates partial resolution of DKA?

  • Arterial pH <7.0
  • Serum bicarbonate >15 mEq/L and normalized anion gap
  • Persistent ketonemia with pH <7.1
  • Glucose still >400 mg/dL

Correct Answer: Serum bicarbonate >15 mEq/L and normalized anion gap

Q29. Which statement is true about HHS (hyperosmolar hyperglycemic state) compared to DKA?

  • HHS always has significant ketosis
  • HHS often has much higher plasma osmolality and minimal ketones
  • HHS presents mainly in type 1 diabetics
  • HHS requires immediate bicarbonate therapy

Correct Answer: HHS often has much higher plasma osmolality and minimal ketones

Q30. Which formula is used to estimate serum osmolality in hyperglycemic crises?

  • 2 × Na + glucose/18 + BUN/2.8
  • Na + K + Cl + HCO3
  • Glucose × 3 only
  • Na × 0.5

Correct Answer: 2 × Na + glucose/18 + BUN/2.8

Q31. Which of the following is a potential precipitating factor for DKA?

  • Infection
  • Excessive insulin dosing
  • Low carbohydrate meal
  • Overhydration

Correct Answer: Infection

Q32. Which medication can mask typical adrenergic symptoms of hypoglycemia during DKA treatment?

  • ACE inhibitors
  • Nonselective beta-blockers
  • Insulin secretagogues
  • Statins

Correct Answer: Nonselective beta-blockers

Q33. In pregnancy, DKA tends to occur at lower glucose levels and requires prompt management because:

  • Fetal acidosis and demise risk increases rapidly
  • Pregnancy protects against cerebral edema
  • Insulin therapy is contraindicated in pregnancy
  • Ketones do not cross the placenta

Correct Answer: Fetal acidosis and demise risk increases rapidly

Q34. Which of the following is the most reliable bedside test for monitoring improvement of ketoacidosis?

  • Urine dipstick for ketones
  • Serial serum beta-hydroxybutyrate levels
  • Breath acetone measurement only
  • Random urine glucose

Correct Answer: Serial serum beta-hydroxybutyrate levels

Q35. Which complication is a recognized risk when aggressively correcting hyperglycemia and sodium disturbances in DKA?

  • Cerebral edema
  • Peripheral neuropathy
  • Chronic retinopathy
  • Chronic kidney disease

Correct Answer: Cerebral edema

Q36. A patient with DKA has serum K+ of 3.1 mEq/L. What is the appropriate immediate action?

  • Administer IV potassium before starting insulin
  • Start insulin infusion and observe
  • Give sodium bicarbonate immediately
  • Give a bolus of insulin then withhold potassium

Correct Answer: Administer IV potassium before starting insulin

Q37. Which of the following best describes the role of phosphate replacement in DKA?

  • Routine high-dose phosphate replacement is recommended for all DKA patients
  • Replace phosphate only if severe hypophosphatemia or clinical symptoms occur
  • Phosphate should never be replaced
  • Replace phosphate only when serum calcium rises

Correct Answer: Replace phosphate only if severe hypophosphatemia or clinical symptoms occur

Q38. Transition from IV insulin infusion to subcutaneous insulin should include:

  • Stopping IV insulin immediately and starting long-acting insulin next day
  • Administering subcutaneous basal insulin 1–2 hours before stopping infusion to prevent rebound hyperglycemia
  • Switching to oral hypoglycemics without overlap
  • Using only sliding scale insulin after stopping infusion

Correct Answer: Administering subcutaneous basal insulin 1–2 hours before stopping infusion to prevent rebound hyperglycemia

Q39. Which serum glucose level is commonly used as a threshold to begin adding dextrose to IV fluids during DKA therapy?

  • <50 mg/dL
  • <300 mg/dL
  • <200 mg/dL
  • <400 mg/dL

Correct Answer: <200 mg/dL

Q40. Which acid–base calculation helps determine if an elevated anion gap is appropriate for the degree of bicarbonate loss?

  • Anion gap only
  • Delta anion gap / delta bicarbonate (delta/delta) ratio
  • Serum osmolality formula
  • Corrected sodium formula

Correct Answer: Delta anion gap / delta bicarbonate (delta/delta) ratio

Q41. Which of the following signs suggests improvement in DKA before complete normalization of labs?

  • Worsening abdominal pain
  • Resolution of altered sensorium and stabilization of hemodynamics
  • Progressive hypotension despite fluids
  • Increasing anion gap

Correct Answer: Resolution of altered sensorium and stabilization of hemodynamics

Q42. Which role is important for a B. Pharm graduate in managing patients with DKA in a clinical setting?

  • Prescribing surgery for DKA
  • Supporting medication selection, counseling on insulin use, and monitoring drug interactions
  • Interpreting radiologic images
  • Performing arterial blood gas punctures routinely

Correct Answer: Supporting medication selection, counseling on insulin use, and monitoring drug interactions

Q43. In DKA, why is serum chloride often elevated relative to baseline?

  • Because of intracellular chloride shift
  • Due to administration of large volumes of 0.9% saline increasing chloride and lowering bicarbonate (hyperchloremic acidosis)
  • Because chloride is produced during ketogenesis
  • Because chloride is released from hepatic stores

Correct Answer: Due to administration of large volumes of 0.9% saline increasing chloride and lowering bicarbonate (hyperchloremic acidosis)

Q44. Which monitoring parameter predicts impending cerebral edema in pediatric DKA?

  • Rapid decline in serum sodium or over-rapid fluid administration with mental status changes
  • Gradual improvement in acid–base status
  • Rising urine output
  • Slow decrease in blood glucose over 48 hours

Correct Answer: Rapid decline in serum sodium or over-rapid fluid administration with mental status changes

Q45. Which intravenous insulin strategy may be used in resource-limited settings when infusion pumps are unavailable?

  • Intermittent subcutaneous rapid-acting insulin every 4 hours with careful monitoring
  • No insulin therapy at all
  • Give long-acting insulin only
  • Single large bolus of insulin followed by no follow-up

Correct Answer: Intermittent subcutaneous rapid-acting insulin every 4 hours with careful monitoring

Q46. What is the primary pharmacologic reason SGLT2 inhibitors can cause euglycemic DKA?

  • They increase insulin secretion dramatically
  • They lower blood glucose yet promote glucagon/ketogenesis and reduce insulin requirement
  • They cause massive sodium retention leading to acidosis
  • They inhibit ketone clearance by the kidney

Correct Answer: They lower blood glucose yet promote glucagon/ketogenesis and reduce insulin requirement

Q47. Which clinical laboratory finding differentiates DKA from simple starvation ketosis?

  • Presence of ketones only
  • High anion gap metabolic acidosis with elevated glucose is more suggestive of DKA
  • Low serum osmolarity points to DKA
  • Starvation ketosis always has severe acidosis with pH <7.0

Correct Answer: High anion gap metabolic acidosis with elevated glucose is more suggestive of DKA

Q48. For B. Pharm students, which counseling point is critical for patients restarting insulin after DKA resolution?

  • Insulin can be stopped once patient feels better
  • Importance of adherence to basal-bolus regimen, sick-day rules, and dose adjustment with oral intake changes
  • Never check blood glucose at home
  • Discontinue all diabetes medications permanently

Correct Answer: Importance of adherence to basal-bolus regimen, sick-day rules, and dose adjustment with oral intake changes

Q49. Which laboratory trend indicates closure of the anion gap in DKA?

  • Persistently low bicarbonate with decreasing glucose
  • Normalization of serum bicarbonate and decrease in beta-hydroxybutyrate with normalized anion gap
  • Rising beta-hydroxybutyrate levels
  • Increasing anion gap despite clinical improvement

Correct Answer: Normalization of serum bicarbonate and decrease in beta-hydroxybutyrate with normalized anion gap

Q50. Which statement best summarizes the pharmacist’s role in preventing DKA?

  • Pharmacists have no role in DKA prevention
  • Ensure medication adherence, counsel on sick-day management, review interactions (e.g., SGLT2 inhibitors) and monitor for early signs
  • Only dispense insulin without counseling
  • Recommend stopping insulin during illness

Correct Answer: Ensure medication adherence, counsel on sick-day management, review interactions (e.g., SGLT2 inhibitors) and monitor for early signs

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