DKA, the acidosis is r/t the ketone bodies found in the body r/t fat metabolism, right?

Question

My nursing instructor continues to tell me that the acidosis is r/t anaerobic metabolism producing lactic acid while the patient is in DKA .... WHAT???!!! I told her this is not correct based on the fact that hyperglycemia and a lack of insulin does NOT cause anaerobic metabolism. Fat metabolism....yes, anaerobic metabolism....no. Am I wrong? Why must we pay 25 grand to learn incorrect bs ??? Please let me know if I am right here.

Answer 1

you're right, I guess your instructor is a bit confused about this topic, nobody's perfect.
DKA is not necessarily accompanied by hypoxia, only in cases with other associated conditions (like sepsis, heart failure, shock, etc). So in DKA the levels of lactate are generally normal.
Yes, ketone bodies come from fats that are metabolized through a wrong pathway in the absence of insulin.

There is another type of acidosis, called lactic acidosis, it's more frequent in diabetics because they have excessive glucose which is metabolised "abnormally" forming lactate, and this is because of hypoxia. In this case we can talk about the anaerobic metabolism of glucose. This condition can be sometimes associated with DKA making the case even more complicated. (rare cases though, you have the lactate AND the ketone bodies high)
You were right, unless she was talking about lactic acidosis occuring in a patient who also had DKA.

Answer 2

I am a rather uneducated person 'medically speaking' but, I did frind several websites that mention both "anaerobic metabolism" and DKA together using the Yahoo search engine. They are at:
www.merckmedicus.com/ppdocs/us/common/cecils/chapters/113_011.htm

www.alaskaems.usanethosting.com/EMSER/Endopuz.ppt

www.rssdi.org/1995_oct-dec/article5.pdf

www.pediatrics.uthscsa.edu/criticalcare/lectures/dka.ppt

I imagine that the combination of excess sugar, blood-acid levels, and the presence of so many bacteria would mean that anaerobic bacteria would have to be present. The information should be available in one of these sites for your enjoyment... Have at it, and GOOD HUNTING.
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