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Diabetes and Acid/Base Chemistry

A Case of Diabetic Ketoacidosis (DKA)

Co Authors:

Eric J. Herrera
Department of Chemistry
California State University, Sacramento

Linda M. Roberts
Department of Chemistry
California State University, Sacramento


This case study focuses on a teenage patient with type 1 diabetes mellitus (T1DM) who presents with severe acidosis, becomes combative and loses consciousness, and is subsequently treated and released. The scenario is used to teach the topics of metabolic hormones, cellular respiration, fat and carbohydrate metabolism, clinical analysis, and treatment. The case incorporates chemistry concepts related to ketone bodies, acid/base chemistry, blood buffer equilibrium, and Le Chatelier's principle in a setting that is pertinent to nursing and health care students. The level of difficulty is appropriate for beginning chemistry students and could be used in secondary or college classrooms. The case includes ample clinical measurements and vitals for performing calculations, which can also be used for graphing exercises. Higher-order topics that could be explored upon completion of the case to assess student understanding include vomiting during acidosis, acidosis related to exercise (lactic acidosis), respiratory acidosis (COPD and pneumonia), and acidosis related to alcoholism.

  • Understand the influence that insulin and glucagon have on carbohydrate and fat metabolism.
  • Describe what ketone bodies are and explain changes in their production in T1DM.
  • Associate ketone bodies with the onset of metabolic acidosis in T1DM.
  • Predict the behavior of the blood buffer equilibrium in response to a physiological change.
  • Use clinical data from a patient with ketoacidosis to explain the biochemical changes that occur before and during treatment.
  • Perform calculations using patient data.
Keywords: Diabetes; type 1 diabetes; ketoacidosis; metabolic hormones; insulin; glucagon; ketoacids; ketone bodies; compensation; Kussmaul respirations; blood buffer equilibrium; BBE; anion gap; acetoacetic acid; pH; metabolism; hyperventilation; bicarbonate
Topical Area: N/A
Educational Level: High school, Undergraduate lower division, Professional (degree program), Continuing education
Formats: PDF
Type/Method: Directed, Interrupted, Journal Article
Language: English
Subject Headings: Biochemistry   Chemistry (General)   Medicinal Chemistry   Medicine (General)   Nursing   Pharmacy / Pharmacology   Public Health   Physiology  
Date Posted: 4/18/2019
Date Modified: N/A
Copyright: Copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

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The following video(s) are recommended for use in association with this case study.

  Kussmaul Breathing Pattern
This video demonstrates the Kussmaul breathing pattern seen with severe acidosis such as diabetic ketoacidosis; initial pH was 6.95 and glucose was 812. Running time: 1:15 min. Produced by Larry Mellick, 2014.

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