Ketoacidosis

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Ketoacidosis
Classification and external resources
DiseasesDB 29670
eMedicine med/102

Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and β-hydroxybutyrate.

Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal.[1]

Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis.

Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct byproduct of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover.[2] Ketosis may also smell, but the odor is usually more subtle due to lower concentrations of acetone.

Etiology[edit]

Two common types are diabetic and alcoholic ketoacidosis.

In diabetic patients, ketoacidosis is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis.

In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate .[citation needed] The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

A mild acidosis may result from prolonged fasting or when following a ketogenic diet or a very low calorie diet.[3][4]

See also[edit]

References[edit]

  1. ^ "Death after soup and water diet". BBC News. 27 July 2009. 
  2. ^ Diabetic ketoacidosis at medical dictionary of National Institutes of Health.
  3. ^ Hartman AL, Vining EP (January 2007). "Clinical aspects of the ketogenic diet". Epilepsia 48 (1): 31–42. doi:10.1111/j.1528-1167.2007.00914.x. PMID 17241206. 
  4. ^ Delbridge E, Proietto J, E; Proietto, J (2006). "State of the science: VLED (Very Low Energy Diet) for obesity". Asia Pac J Clin Nutr 15: 49–54. PMID 16928661. 

External links[edit]