Mental status may be impaired. In addition to metabolic acidosis due to ketone formation, a metabolic alkalosis may be present due to vomiting and volume depletion. A respiratory alkalosis may be present secondary to hyperventilation. Therefore, ketosis may be more severe than would be inferred from nitroprusside reaction alone. With initial therapy, ketone formation possibly shifts enough toward the production of AcAc that measured ketone levels rise, even though BOHB levels decrease.
Anion gap is elevated.
Lactate levels also may be elevated. Phosphorous levels may be low, normal, or elevated. BUN and creatinine may be elevated. The serum lactate may be modestly elevated. Complete blood count Anemia secondary to nutritional deficiencies, alcoholic bone marrow suppression, or GI bleeding may be present.