Which ketone is predominant in diabetic ketoacidosis?

• A. Beta-hydroxybutyrate.
• B. Acetone.
• C. Propionate.
• D. Lactic acid.

Answer: (A)

In diabetic ketoacidosis the liver pumps out ketone bodies because insulin is deficient and counterregulatory hormones are high, driving rapid lipolysis and fatty acid delivery to the liver. The ketogenesis pathway in the mitochondria produces acetoacetate and beta-hydroxybutyrate, but the cellular redox state shifts toward beta-hydroxybutyrate when NADH is elevated during intense fatty acid oxidation. That shift makes beta-hydroxybutyrate accumulate more than acetoacetate, so it becomes the predominant ketone body in the blood during DKA. Acetone is formed from acetoacetate and is mainly a volatile byproduct with a fruity breath signature, not the major circulating ketone. Propionate and lactic acid are not the primary ketone bodies produced in this setting.