{"id":1907,"date":"2022-07-13T14:36:00","date_gmt":"2022-07-13T14:36:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1907"},"modified":"2026-02-19T17:43:25","modified_gmt":"2026-02-20T01:43:25","slug":"usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Diabetic Ketoacidosis (DKA)"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves an 18-year-old woman with a history of type 1 diabetes mellitus who&nbsp;complains of nausea and flank pain. Can you figure it out? Let&#8217;s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An <strong>18-year-old woman<\/strong> comes to the emergency department complaining of <strong>nausea <\/strong>and <strong>flank pain<\/strong>. Over the past 24 hours, she developed pain in her right flank, along with <strong>fevers <\/strong>and several episodes of <strong>non-bilious, non-bloody vomiting<\/strong>. She has a history of <strong>type 1 diabetes mellitus<\/strong> and uses an <strong>insulin pump <\/strong>which is currently in place and appears to be functioning properly. The patient\u2019s <strong>temperature is 38.9\u00b0C (102\u00b0F), pulse is 115\/min, respirations are 25\/min, and blood pressure is 95\/60 mmHg.<\/strong> Physical examination shows a thin, uncomfortable woman with legs flexed to her chest in the <strong>right lateral decubitus position<\/strong>. She is <strong>breathing deeply<\/strong>. Lightly tapping over her <strong>right lower back<\/strong> causes her to jump in pain. Sensation to light <strong>touch is diminished<\/strong> on the <strong>plantar surfaces<\/strong> of both feet. Laboratory studies show the following:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Laboratory value<\/strong><\/td><td><strong>Result<\/strong><\/td><\/tr><tr><td>Hemoglobin<\/td><td>12 g\/dL<\/td><\/tr><tr><td>Hematocrit<\/td><td>36 %<\/td><\/tr><tr><td>Leukocyte count<\/td><td>16,000\/mm3<\/td><\/tr><tr><td>Platelet count<\/td><td>400,000\/mm3<\/td><\/tr><tr><td>Sodium<\/td><td>130 mEq\/L<\/td><\/tr><tr><td>Potassium<\/td><td>5.0 mEq\/L<\/td><\/tr><tr><td>Chloride<\/td><td>100 mEq\/L<\/td><\/tr><tr><td>Bicarbonate<\/td><td>14 mEq\/L<\/td><\/tr><tr><td>Blood urea nitrogen<\/td><td>15 mg\/dL<\/td><\/tr><tr><td>Creatinine<\/td><td>1.0 mg\/dL<\/td><\/tr><tr><td>Glucose<\/td><td>500 mg\/dL<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following solutes is <em>most important<\/em> to replenish at this point in time?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Sodium<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Potassium<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Chloride<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Bicarbonate<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Glucose<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Scroll down for the correct answer!<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Sri Lanka learns by Osmosis.org!\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/kXiwwxlWAV8?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Check out our free<a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-2\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;<u>USMLE\u00ae Step 2 Ultimate Guide!<\/u><\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Potassium<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, C, D or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Sodium<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: An increase in <strong>extracellular glucose<\/strong> concentration moves water out of cells, causing <strong>dilution of extracellular sodium<\/strong> and a <strong>falsely low serum sodium level <\/strong>on lab values. For every <strong>100 mg\/dL of glucose over 100,<\/strong> you can expect a <strong>1.6 drop in sodium.<\/strong> This patient\u2019s corrected sodium level is normal at <strong>136 mEq\/L<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Chloride<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: <strong>Serum chloride<\/strong> levels are usually normal in patients with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetic_ketoacidosis_(DKA):_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>diabetic ketoacidosis<\/strong><\/a>&nbsp;and do not require <strong>focused repletion<\/strong> beyond what is given in <strong>isotonic fluids.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Bicarbonate<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Although this patient\u2019s bicarbonate is low, indicating <strong>diabetic ketoacidosis<\/strong>, the proper way to fix it is by treating the <strong>underlying cause<\/strong> with <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Insulin\" target=\"_blank\" rel=\"noreferrer noopener\">insulin<\/a>&nbsp;<\/strong>and <strong>intravenous fluids<\/strong>. Clinical trials do not support the routine use of bicarbonate replacement in&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetic_ketoacidosis_(DKA):_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\">diabetic ketoacidosis<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Glucose<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Treating&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetic_ketoacidosis_(DKA):_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\">diabetic ketoacidosis<\/a>&nbsp;requires&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Insulin\" target=\"_blank\" rel=\"noreferrer noopener\">insulin<\/a>&nbsp;to allow the body to process all of the built up extracellular glucose. Only once the <strong>plasma glucose reaches 200-250 mg\/dL<\/strong> is glucose added to the insulin infusion to prevent massive drops in <strong>serum glucose<\/strong>, which can cause <strong>cerebral edema<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient is presenting with signs and symptoms of <strong>pyelonephritis <\/strong>in the setting of well-controlled&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_mellitus:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">type 1 diabetes mellitus<\/a>&nbsp;with evidence of <strong>chronic peripheral neuropathy<\/strong> (extremity numbness).&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Chronic_pyelonephritis\" target=\"_blank\" rel=\"noreferrer noopener\">Pyelonephritis<\/a>,<\/strong> or an <strong>infection of the kidney<\/strong>, is more common in diabetic patients and causes <strong>nausea, vomiting, fever, leukocytosis, <\/strong>and <strong>flank pain<\/strong> with <strong>costovertebral tenderness<\/strong> on physical examination. Although this patient\u2019s diabetes has stably been controlled on her insulin pump, infections increase the body\u2019s&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Insulin\" target=\"_blank\" rel=\"noreferrer noopener\">insulin<\/a> requirement and are thus a <strong>common trigger<\/strong> for&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetic_ketoacidosis_(DKA):_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\">diabetic ketoacidosis (DKA)<\/a>. Without any insulin, <strong>lipolysis occurs<\/strong> and the liver starts to turn fatty acids into ketone bodies, such as&nbsp;aceto-acetic acid&nbsp;and&nbsp;beta hydroxybutyric acid, thereby <strong>increasing the acidity of the blood<\/strong>, causing an&nbsp;<strong>anion-gap&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Metabolic_acidosis\" target=\"_blank\" rel=\"noreferrer noopener\">metabolic acidosis<\/a><\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"652\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T083810.813.png?w=1024\" alt=\"Illustration of the hyperkalemia process showing depleted and low stores of  K+.\" class=\"wp-image-1910\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T083810.813.png 1164w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T083810.813.png?resize=300,191 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T083810.813.png?resize=768,489 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T083810.813.png?resize=1024,652 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Clinically, <strong>individuals with DKA<\/strong> are <strong>dehydrated <\/strong>from <strong>hyperglycemic polyuria<\/strong>. The acidosis causes&nbsp;<strong>Kussmaul respiration<\/strong>, which is <strong>deep and rapid breathing<\/strong> as the body tries to move <strong>carbon dioxide<\/strong> out of the blood to <strong>reduce its acidity.<\/strong> <strong>Abdominal pain, nausea, vomiting, <\/strong>and <strong>mental status<\/strong> changes like <strong>delirium <\/strong>and <strong>psychosis <\/strong>can occur. Laboratory results show <strong>hyperglycemia with low serum pH and low bicarbonate.<\/strong> The anion gap is high, which reflects a large difference in the unmeasured negative and positive ions in the serum, largely due to this build-up of ketoacids.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Potassium <\/strong>is critically important to replete in DKA. Recall that cells have a transporter that <strong>exchanges hydrogen ions for potassium<\/strong>. When the blood gets acidic, there are many <strong>positively charged hydrogen ions<\/strong> present in the blood. Cells will exchange these <strong>extracellular protons with intracellular potassium<\/strong>, so initially there will be&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperkalemia:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>hyperkalemia<\/strong><\/a>. In addition to helping glucose enter cells, <a href=\"https:\/\/www.osmosis.org\/learn\/Insulin\" target=\"_blank\" rel=\"noreferrer noopener\">insulin<\/a>&nbsp;also <strong>stimulates the sodium-potassium ATPases<\/strong> that help potassium get into cells; without insulin, more potassium stays in the <strong>extracellular fluid<\/strong>. Since this extracellular potassium is quickly excreted, even though the blood potassium levels remain high,&nbsp;<strong>total body potassium is depleted<\/strong>. Therefore, <strong>treatment of DKA<\/strong> relies on <strong>IV fluids to correct dehydration, IV insulin to reverse lipolysis,<\/strong> and&nbsp;<strong>aggressive potassium repletion<\/strong>&nbsp;as soon as serum potassium levels are in the normal range.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Diabetic_ketoacidosis_(DKA):_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\">Diabetic ketoacidosis<\/a><\/strong>&nbsp;can occur in patients with&nbsp;<strong>type 1 diabetes<\/strong>&nbsp;if they are <strong>stressed <\/strong>or have <strong>missed&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Insulin\" target=\"_blank\" rel=\"noreferrer noopener\">insulin<\/a><\/strong>&nbsp;doses. Laboratory studies show an <strong>anion-gap metabolic acidosis with hyperglycemia<\/strong> causing spuriously low sodium levels. Acidemia with extracellular potassium wasting results in&nbsp;<strong>depleted total body potassium stores,<\/strong>&nbsp;even though the blood level may be normal or elevated, and potassium repletion should begin immediately.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video: <a href=\"https:\/\/www.osmosis.org\/learn\/Diabetic_ketoacidosis:_Clinical_sciences\">Diabetic ketoacidosis: Clinical sciences<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Powers, A. C., Niswender, K. D., &amp; Rickels, M. R. (2018).&nbsp;<a href=\"https:\/\/accessmedicine.mhmedical.com\/content.aspx?bookid=2129&amp;sectionid=192288322\" target=\"_blank\" rel=\"noreferrer noopener\">Diabetes Mellitus: Management and Therapies<\/a>. In J. L. Jameson, A. S. Fauci, D. L. Kasper, S. L. Hauser, D. L. Longo, &amp; J. Loscalzo (Eds.),&nbsp;<em>Harrison\u2019s Principles of Internal Medicine<\/em>&nbsp;(20th ed.). McGraw-Hill Education.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T083934.275.png\" alt=\"Ace your clerkships with clinical practice videos on Osmosis ad\" class=\"wp-image-1911\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T083934.275.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T083934.275.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 2 CK practice questions<\/strong>?\u00a0Try Osmosis from Elsevier today! Get your\u00a0<a href=\"https:\/\/www.osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a>\u00a0and find out why millions of current and future <strong>clinicians and caregivers love learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>An 18-year-old with type 1 diabetes presents with nausea and flank pain. Explore the key lab findings and learn which electrolyte is vital to replenish in this DKA case.<\/p>\n","protected":false},"author":202,"featured_media":1908,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1370,45],"tags":[1131,625,1135,1028,1132,1137,1133,1136,1134,952],"class_list":["post-1907","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-2-questions","category-step-2","tag-diabetic-ketoacidosis","tag-diabetic-neuropathy","tag-dka","tag-electrolyte-imbalance","tag-insulin-therapy","tag-metabolic-acidosis","tag-potassium","tag-pyelonephritis","tag-type-1-diabetes","tag-usmle-step-2-ck"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Diabetic Ketoacidosis (DKA) - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Diabetic Ketoacidosis (DKA) - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"An 18-year-old with type 1 diabetes presents with nausea and flank pain. Explore the key lab findings and learn which electrolyte is vital to replenish in this DKA case.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2022-07-13T14:36:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-02-20T01:43:25+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/72.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1081\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-diabetic-ketoacidosis-dka\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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