In a patient with severe diabetes who becomes unresponsive, which finding would indicate fat metabolism with ketone body excretion?

• A. Ketonuria
• B. Hypernatremia
• C. Anion gap metabolic alkalosis
• D. Hypercalcemia

Answer: (A)

When insulin is deficient, the body looks to fat stores for energy and fatty acids are released and sent to the liver, where they are converted into ketone bodies. These ketone bodies—such as acetoacetate and beta-hydroxybutyrate—are then excreted in the urine, producing ketonuria. In a severely diabetic patient who becomes unresponsive, this pattern points to diabetic ketoacidosis, where ketone production and excretion are key features. So ketonuria is the finding that directly indicates fat metabolism with ketone body excretion.

Hypernatremia can occur with dehydration from osmotic diuresis but doesn’t specifically reflect ketone production. An anion gap metabolic alkalosis would contradict the typical acidosis seen in diabetic ketoacidosis, which is an increased anion gap metabolic acidosis. Hypercalcemia is not related to ketone production in this context.