DKA vs other types of ketoacidosis

Diabetic ketoacidosis

Diabetic ketoacidosis usually presents with an increased anion gap metabolic acidosis due to accumulation of β-hydroxybutyrate and acetoacetate, although it may present with a normal anion gap due to excretion of ketoacids. Compensatory hyperventilation is characterized by increased tidal volume rather than increase in respiratory rate. Urine dipstick assays for ketones detect acetoacetate using the nitroprusside assay; however, β-hydroxybutyrate is the dominant ketoacid in diabetic ketoacidosis, so urine dipstick results can be falsely negative or underestimate the total ketone load.

Alcoholic ketoacidosis

Alcoholic ketoacidosis occurs in patients with chronic ethanol abuse who typically have a history of recent binge drinking, little food intake, and persistent vomiting. Liver chemistry test abnormalities may be present due to concomitant alcoholic hepatitis. Treatment with intravenous saline and intravenous glucose typically results in rapid resolution of ketones due to induction of insulin secretion and suppression of glucagon release. For patients with chronic malnutrition related to alcohol use, thiamine should be administered before glucose to decrease the risk of precipitating Wernicke encephalopathy.

Starvation

Starvation ketoacidosis (due to lipolysis with formation of free fatty acids and conversion into ketones) also causes ketonuria and an osmolar gap.  However, these patients typically have a high AGMA.