Laboratory investigation reveals an anion gap metabolic acidosis. However, the serum pH may vary as these patients often have mixed acid-basedisorders such as a metabolic acidosis from AKA and a metabolic alkalosis from vomiting and dehydration. Blood glucose is low to mildly elevated. The alcohol level is usually low or 0 as symptoms limit intake. Serum ketones, acetoacetate, and β-hydroxybutyrate, are elevated. If the nitroprusside test is used to measure serum and urine ketones, acetoacetate is detected but not β-hydroxybutyrate. The redox state may be such that most or all acetoacetate is reduced to β-hydroxybutyrate, which may result in a false negative or falsely low result.