Which specific ketones are primarily responsible for the metabolic acidosis in DKA?

In diabetic ketoacidosis (DKA), the primary ketone bodies that contribute to metabolic acidosis are beta-hydroxybutyrate and acetoacetate. During periods of low insulin availability, the body mobilizes fatty acids, which are then converted into ketones in the liver.

Beta-hydroxybutyrate is the most abundant ketone produced in DKA and is responsible for a significant portion of the acidosis. It is both produced and utilized by tissues but accumulates during states of insulin deficiency. Acetoacetate, while present in smaller amounts compared to beta-hydroxybutyrate, also contributes to the acidotic state.

Together, these ketones lead to a decrease in blood pH, resulting in metabolic acidosis. Their presence in excess is a hallmark of DKA and is essential to understanding the pathophysiology of this condition. This makes beta-hydroxybutyrate and acetoacetate the specific ketones primarily responsible for the metabolic acidosis observed in DKA.