Critical Care Medicine-Endocrine Disorders>>>>>Diabetes Mellitus
Question 4#

All of the following contribute to the development of diabetic ketoacidosis (DKA) EXCEPT: 

A. Insulin deficiency
B. Increased secretion of catecholamines, cortisol, and growth hormone
C. Glucagon deficiency
D. Increased lipolysis

Correct Answer is C

Comment:

Correct Answer: C

DKA results from insulin deficiency and increased levels of glucagon. In addition, there is increased secretion of catecholamines, cortisol, and growth hormone, which counteract the action of any residual insulin. Absolute insulin deficiency results in increased lipolysis resulting in increased free fatty acids that are oxidized to ketone bodies in the liver. Increased levels of catecholamines, cortisol, and growth hormone result in increased gluconeogenesis and glycogenolysis, and hyperglycemia. 

References:

1. Hirsch IB, Emmett M. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: epidemiology and pathogenesis. In: Nathan DM, Wolfsdorf JI, eds. UpToDate. Waltham, MA: UpToDate, Inc. http://www.uptodate.com. Accessed August 28, 2018.
2. Umpierrez G, Korykowski M. Diabetic emergencies – ketoacidosis, hyperglycemic hyperosmolar state, and hypoglycemia. Nat Rev Endocrinol. 2016;12:222-232.