Why Do Ketone Bodies Cause Acidosis?

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Jaime Moo-young, Md

Diabetic Ketoacidosis (DKA) Pathogenesis · Insufficient insulin for a given carbohydrate load decreased cellular metabolism of glucose · Increased gluconeogenesis, glycogenolysisHyperglycemia · Increased breakdown of free fatty acids as alternative energy source ketone and ketoacid accumulation · Hyperglycemiaserum hyperosmolality osmotic diuresis dehydration and electrolyte derangements (dehydration is most lethal!) · Seen almost exclusively in Type I diabetes; rarely in Type II Definition: Triad of 1. Hyperglycemia (usually between 500 – 800 mg/dL or 27.8-44.4 mmol/L) 2. Anion Gap Metabolic Acidosis (pH usually <7.30) 3. Ketonemia: -hydroxybutyrate, acetoacetate most significant ** Urine ketones do not make the diagnosis, but they can support it** Triggers (the “I’sâ€): Don’t forget to ask about these! · Insulin deficiency: insulin non-compliance, insufficient insulin dosing, new-onset Type I diabetes · Iatrognic: glucocorticoids, atypical antipsychotics, high-dose thiazide diuretics · Infection: UTI, pneumonia, TB · Inflammation: pancreatitis, cholecystitis · Ischemia/infarction: MI, stroke, gut ischemia · Intoxicati Continue reading >>

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Popular Questions

  1. Knicks

    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment.

  2. generic

    The HCO3 derangement is not a compensation--it is the primary problem.
    DKA patients have a metabolic acidosis, I think it's mostly caused by the formation of tons and tons of ketone bodies (acidic). These are formed because despite high circulating levels of glucose, the cells can't use the glucose without insulin-->turn to ketone formation instead.
    The metabolic acidosis may cause respiratory compensation, which would give Kussmaul breathing, for example.

  3. treva

    Knicks said: ↑
    In DKA, the patient is acidotic, right? So why would the body decrease bicarbonate (a base)? Wouldn't you want to keep the bicarbonate high so as to neutralize the acid?
    Too tired to think straight at the moment. Remember the kidney takes days to compensate for acidodic state by producing more bicarb. Acutely, the bicarb is used to buffer the extra acid, so it drops.
    This also explains why DKA pts have increased RR:
    CO2 + H20 <--> H2CO3 <--> HCO3- + H+
    If you blow off extra CO2 (ie by upping RR) you shift the above equation to the left, and promote the formation of H2CO3 via CA, helping to mop up the H+.

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