Which of the following conditions can cause an increased anion gap?

An increased anion gap is typically associated with metabolic acidosis, particularly when there is an accumulation of unmeasured anions in the serum. In the case of diabetic ketoacidosis, the body produces excess ketone bodies—acetoacetate and beta-hydroxybutyrate—due to a lack of insulin. These ketone bodies contribute to an elevation in the anion gap because they are not included in the standard measurement of electrolytes.

In diabetic ketoacidosis, the combination of hyperglycemia, acidosis, and ketonemia drives this metabolic derangement, causing an increased anion gap that reflects an underlying pathological state. Recognizing this condition is crucial in the acute care setting as it can lead to significant metabolic disturbances requiring prompt management.

While conditions like acute renal failure can potentially lead to an increased anion gap due to the accumulation of nitrogenous waste products and other unmeasured anions, diabetic ketoacidosis is a classic, well-defined cause primarily linked to the production of ketoacids. The other options, such as diarrhea and hyperemesis gravidarum, typically result in a normal or decreased anion gap associated with loss of bicarbonate rather than an increase, reinforcing the specificity of diabetic keto