Diabetic ketoacidosis (DKA) primarily leads to which acid-base imbalance?

Diabetic ketoacidosis (DKA) primarily leads to metabolic acidosis due to the accumulation of ketoacids in the blood as a result of insufficient insulin, which causes the body to break down fat for energy. This process generates ketones, which are acidic. The presence of these acids decreases the bicarbonate concentration in the blood, reducing the pH and resulting in a state of acidosis.

In DKA, the body also attempts to compensate for this metabolic acidosis through respiratory mechanisms, such as hyperventilation (Kussmaul respirations), to blow off carbon dioxide, which can help raise the pH back toward normal. However, this is a compensatory response rather than a primary source of the acid-base imbalance. The primary disturbance remains a decrease in bicarbonate levels and an increase in hydrogen ions, leading to the classification of the condition as metabolic acidosis.