Ketoacidosis Associated With Low-carbohydrate Diet In A Non-diabetic Lactating Woman: A Case Report
Go to: Case presentation A 32-year-old white woman presented to our county hospital with a history of nausea, vomiting, heart palpitations, trembling and extremity spasms. She had started a strict LCHF diet, with an estimated carbohydrate intake of less than 20g per day, 10 days before admittance, lost 4 kilograms and had felt growing malaise. She was breastfeeding her son of 10 months of age. She continuously denied any alcohol or drug intake. She had a past medical history of hypothyreosis and had a family history of high blood pressure but not for diabetes. She took acetaminophen occasionally but no other medications. The initial examination in the emergency department revealed an unaffected woman with respiratory rate of 12 breaths per minute, oxygen saturation 96% on room air, body temperature 36.3°C, pulse 102 beats per minute and blood pressure of 110/80mmHg. Nothing abnormal was revealed on examination of her heart, lungs, abdomen and thyroid gland. An arterial blood gas was taken. It revealed pH 7.20, base excess (BE) −19, partial pressure of carbon dioxide (pCO2) 2.8 kPa, glucose 3.8mmol/l and lactate 1.0mmol/l. Her blood ketones were 7.1mmol/l (reference 0 to 0.5mmol/l). No genetic testing of any kind was performed. The primary diagnosis was thought to be ketoacidosis due to starvation induced by the LCHF diet but blood samples for s-paracetamol, s-salicylate, s-ethanol, s-methanol, s-ethylene glycol, kidney function, diabetic autoantibodies, plasma cortisol (p-cortisol) and tests for thyroid function were added. She was admitted to our medical ward, given an intramuscular vitamin B injection and started on a 10% glucose infusion. In total 3L of glucose were infused, with an infusion rate of 125mL/hour, during 48 hours. The following day, after glucose inf Continue reading >>
Why Dka & Nutritional Ketosis Are Not The Same
There’s a very common misconception and general misunderstanding around ketones. Specifically, the misunderstandings lie in the areas of: ketones that are produced in low-carb diets of generally less than 50 grams of carbs per day, which is low enough to put a person in a state of “nutritional ketosis” ketones that are produced when a diabetic is in a state of “diabetic ketoacidosis” (DKA) and lastly, there are “starvation ketones” and “illness-induced ketones” The fact is they are very different. DKA is a dangerous state of ketosis that can easily land a diabetic in the hospital and is life-threatening. Meanwhile, “nutritional ketosis” is the result of a nutritional approach that both non-diabetics and diabetics can safely achieve through low-carb nutrition. Diabetic Ketoacidosis vs. Nutritional Ketosis Ryan Attar (soon to be Ryan Attar, ND) helps explain the science and actual human physiology behind these different types of ketone production. Ryan is currently studying to become a Doctor of Naturopathic Medicine in Connecticut and also pursuing a Masters Degree in Human Nutrition. He has interned under the supervision of the very well-known diabetes doc, Dr. Bernstein. Ryan explains: Diabetic Ketoacidosis: “Diabetic Ketoacidosis (DKA), is a very dangerous state where an individual with uncontrolled diabetes is effectively starving due to lack of insulin. Insulin brings glucose into our cells and without it the body switches to ketones. Our brain can function off either glucose or fat and ketones. Ketones are a breakdown of fat and amino acids that can travel through the blood to various tissues to be utilized for fuel.” “In normal individuals, or those with well controlled diabetes, insulin acts to cancel the feedback loop and slow and sto Continue reading >>
Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation
Abstract Ketoacidosis is a potential complication of type 1 diabetes. Severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. Three weeks after delivery, a young woman was admitted because of tachypnoe and tachycardia. Blood gas analysis showed a severe metabolic acidosis with a high anion gap. Further workup revealed the presence of ketone bodies in the urine with normal blood glucose and no history of diabetes. The patient reported that she had not eaten for days because of abdominal pain. After initial treatment in the ICU and immediate re-feeding, the patient’s condition rapidly improved. While under normal circumstances fasting causes at most only mild acidosis, it can be dangerous during lactation. Prolonged fasting in combination with different forms of stress puts breast feeding women at risk for starvation ketoacidosis and should therefore be avoided. Background Severe acidosis is a potentially life-threatening condition. In case of metabolic acidosis, determination of the serum anion gap helps to narrow down the differential diagnosis. An increased anion gap indicates the presence of an unusual amount of an acid that is most commonly found in ketoacidosis, lactic acidosis, renal insufficiency, and intoxications while other causes are rare. Ketoacidosis is a potential complication of type 1 diabetes while severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. In diabetic ketoacidosis, glucose is not properly taken up into tissue due to an absolute insulin deficiency that is mainly found in type 1 diabetes. In parallel, glucagon release is not suppressed leading to hyperglucagonemia. Subsequently the body activates stress hormones, which worsen hyperglycemia by promoting gluconeogenesis (and also ketog Continue reading >>
Ketones: Clearing Up The Confusion
Ketones, ketosis, ketoacidosis, DKA…these are words that you’ve probably heard at one point or another, and you might be wondering what they mean and if you need to worry about them at all, especially if you have diabetes. This week, we’ll explore the mysterious world of ketones, including if and how they may affect you. Ketones — what are they? Ketones are a type of acid that the body can form if there’s not enough carbohydrate to be burned for energy (yes, you do need carbs for fuel). Without enough carb, the body turns to another energy source: fat. Ketones are made in the liver from fat breakdown. This is called ketogenesis. People who don’t have diabetes can form ketones. This might occur if a person does extreme exercise, has an eating disorder, is fasting (not eating), or is following a low-carbohydrate diet. This is called ketosis and it’s a normal response to starvation. In a person who has diabetes, ketones form for the same reason (not enough carb for energy), but this often occurs because there isn’t enough insulin available to help move carb (in the form of glucose) from the bloodstream to the cells to be used for energy. Again, the body scrambles to find an alternate fuel source in the form of fat. You might be thinking that it’s a good thing to burn fat for fuel. However, for someone who has diabetes, ketosis can quickly become dangerous if it occurs due to a continued lack of insulin (the presence of ketones along with “normal” blood sugar levels is not necessarily a cause for concern). In the absence of insulin (which can occur if someone doesn’t take their insulin or perhaps uses an insulin pump and the pump has a malfunction, for example), fat cells continue to release fat into the circulation; the liver then continues to churn Continue reading >>
Ketoacidosis
GENERAL ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions). ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. a relative or absolute insulin deficiency is present in all cases. CAUSES The three major types of ketosis are: (i) Starvation ketosis (ii) Alcoholic ketoacidosis (iii) Diabetic ketoacidosis STARVATION KETOSIS when hepatic glycogen stores are exhausted (eg after 12-24 hours of total fasting), the liver produces ketones to provide an energy substrate for peripheral tissues. ketoacidosis can appear after an overnight fast but it typically requires 3 to 14 days of starvation to reach maximal severity. typical keto-anion levels are only 1 to 2 mmol/l and this will usually not alter the anion gap. the acidosis even with quite prolonged fasting is only ever of mild to moderate severity with keto-anion levels up to a maximum of 3 to 5 mmol/l and plasma pH down to 7.3. ketone bodies also stimulate some insulin release from the islets. patients are usually not diabetic. ALCOHOLIC KETOSIS Presentation a chronic alcoholic who has a binge, then stops drinking and has little or no oral food intake for a few days (ethanol and fasting) volume depletion is common and this can result in increased levels of counter regulatory hormones (eg glucagon) levels of free fatty acids (FFA) can be high (eg up to 3.5mM) providing plenty of substrate for the altered hepatic lipid metabolism to produce plenty of ketoanions GI symptoms are common (eg nausea, vomiting, abdominal pain, haematemesis, melaena) acidaemia may be severe (eg pH down to 7.0) plasma glucose may be depressed or normal or Continue reading >>
Fasting Ketosis Symptoms: Common Side Effects
Ketosis is one of the natural, physiological effects of the body when fasting. When we’re eating a ketogenic diet or have gone on an extended period of time without food, our bodies will enter ketosis. This is because the body no longer has glucose available and begins breaking down the body’s fatty tissues for energy. With the ketogenic diet, we’re inducing ketosis by “starving” the body of carbohydrates so that it must turn to fat burning, which has many benefits. Simply fasting by not eating any food can have the same effect. Many people on the ketogenic diet will incorporate fasting to speed up ketosis and also reap the benefits of fasting on keto. Whether you’re eating a ketogenic diet, simply fasting, or combining the two, your body is entering ketosis. Since the symptoms can be similar, this article covers the common fasting ketosis symptoms, as well as how to deal with them. Fasting Ketosis Symptoms It’s important to note that most of these symptoms are temporary as your body is getting adapted to being in ketosis and can be remedied by the tips we cover below. Ketosis Flu If you’re using fasting as a way to get into (or get back into) ketosis, you might experience what’s commonly known as the “keto flu” as the body adapts to fat burning. The keto flu typically includes symptoms like: Water Flushing As your body burns through its glucose and stored glycogen during a fast, a lot of water is released. Your kidneys will also excrete more sodium as insulin drops. This is why people who start low-carb often experience a big initial loss of water weight and reduced bloating. Fatigue With the loss of excess water, the body also flushes out electrolytes like sodium, potassium, and magnesium. This can cause you to feel lightheaded and fatigued more Continue reading >>
The Difference Between Ketosis And Ketoacidosis
When you hear these two terms it’s easy to see how they can be confused. The confusion also stems from the fact that the two are both metabolic processes involving the breakdown of fats in the body (plus they look and sound like similar words). The truth is ketosis and ketoacidosis are two completely different things. Ketosis and the Ketogenic Diet Ketosis is a normal metabolic process in which the body has a high fat-burning rate. It is a healthy and natural state your body enters when your body is running on fat rather than glucose1. The state of ketosis occurs when ketone levels are raised in the blood due to the conversion of fats into fatty acids and ketones. This happens when the body runs out of carbohydrates – usually because a person hasn’t eaten in a while, for example during fasts, or they eat a very low-carbohydrate diet – leaving little sugar to convert into glycogen. Without glycogen, the body breaks down fat cells for energy. A low-carb, high fat diet, also known as a ketogenic diet, is necessary to enter and stay in ketosis long-term. When you eat a low-carbohydrate diet, your body enters the metabolic state of ketosis within 2 days but it can vary from person to person. There are many benefits2 to being in longer-term ketosis including: lowered triglycerides levels no spikes in blood glucose levels greater mental clarity lowered blood pressure and cholesterol reduced food and sugar cravings weight loss Ketoacidosis – The Body in a State of Toxicity Ketoacidosis is a metabolic state of toxicity. It occurs when the body fails to regulate ketone production resulting in severe accumulation of keto acids which cause the pH of the blood to decrease substantially making the blood more acidic. The most common causes for ketoacidosis are Type 1 Diabete Continue reading >>
Fasting Ketosis And Alcoholic Ketoacidosis
INTRODUCTION Ketoacidosis is the term used for metabolic acidoses associated with an accumulation of ketone bodies. The most common cause of ketoacidosis is diabetic ketoacidosis. Two other causes are fasting ketosis and alcoholic ketoacidosis. Fasting ketosis and alcoholic ketoacidosis will be reviewed here. Issues related to diabetic ketoacidosis are discussed in detail elsewhere. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment".) PHYSIOLOGY OF KETONE BODIES There are three major ketone bodies, with the interrelationships shown in the figure (figure 1): Acetoacetic acid is the only true ketoacid. The more dominant acid in patients with ketoacidosis is beta-hydroxybutyric acid, which results from the reduction of acetoacetic acid by NADH. Beta-hydroxybutyric acid is a hydroxyacid, not a true ketoacid. Continue reading >>
Water Fasting Ketosis Is Where The Fat Burn Heaven Begins
In this guide, you will learn everything you need to know about water fasting ketosis. I'll explain how water fasting can help you reach your absolute highest possible fat burn rates, which is easily the single biggest benefit of ketosis. You'll also see the science on how long it actually takes before you can enter ketosis during a water fast. You'll also learn about one of the most dangerous problems of water fasting ketosis. I'll also tell you why it is a very good idea to avoid one of the most common mistakes people make once they already reach ketosis during a water fast. Now that you know what you're getting yourself into, here's a quick overview of everything that's covered in this guide: The single biggest benefit of water fasting ketosis Simply put, ketosis is a state where you get to enjoy your absolutely highest possible fat burn rates. If you're on your regular diet, your body can draw energy from a couple of different sources (so not just from your body fat reserves). Those other, non-fat energy sources are the main reason why your fat burn rates stay on the low end, even if you start eating less food. But during a water fast, because you're eating no food at all, those other energy sources in your body will be completely wiped out after a while. Once that happens, your body will enter full ketosis, and in that state of full ketosis, your body will have no choice but to rely almost exclusively on your body fat reserves. With no other energy sources available, ketosis will trigger some pretty amazing fat burn rates in your body. Water fasting is one of the fastest ways to reach that state of super high fat burn. And a lot of people do a water fast just for this reason. There's only one problem with reaching ketosis through water fasting. PRO TIP: A different Continue reading >>
Effects Of Fasting Ketosis | Allaboutfasting
Understanding ketosis and muscle loss during fasting. The process of ketosis is one of the physiological effects of fasting in which the brain (and some other bodily processes) uses ketones produced from fatty tissues as a fuel instead of the usual glucose. This is called "muscle sparing". When glucose isn't readily available via the diet (in the form of carbohydrates) and the glycogen stores in the liver become depleted, the body could break down muscle to get it. But ketosis is an adaptation that will spare muscle during times of shortage by instead breaking down fat stores and manufacturing ketones for brain fuel. It is said this state is attained at approximately 48 hours of a water fast for women and closer to 72 hours for men. The effects of fasting ketosis became a more popular and controversial subject about 10 years ago due to low-carb, high-protein dieters relying on it long-term to "burn the fat". Recent iterations of these "ketogenic diets" are fine-tuning fat to protein to carb ratios. Where ketosis was once considered a "crisis response" of the body and fine only for short durations, there are some diet doctors who now contend ketones are an acceptable alternative fuel, produced and used by the body any time glucose is scarce, which can happen even in non-fasting, non-dieting individuals, such as during intense exercise or during sleep. They are considering it a natural metabolic process where ketone production and use fluctuates constantly in response to the body's needs. What is so controversial about the dieters' use of ketosis is the long term, artificially produced, use of it. Over long periods of time, their high-protein diet produces excess protein by-products that become a strain on the kidneys to eliminate. Ketosis also creates a mild acidosis of Continue reading >>
Ketosis
Not to be confused with Ketoacidosis. Ketosis is a metabolic state in which some of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis in which blood glucose provides energy. Ketosis is a result of metabolizing fat to provide energy. Ketosis is a nutritional process characterised by serum concentrations of ketone bodies over 0.5 mM, with low and stable levels of insulin and blood glucose.[1][2] It is almost always generalized with hyperketonemia, that is, an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are depleted (or from metabolising medium-chain triglycerides[3]). The main ketone bodies used for energy are acetoacetate and β-hydroxybutyrate,[4] and the levels of ketone bodies are regulated mainly by insulin and glucagon.[5] Most cells in the body can use both glucose and ketone bodies for fuel, and during ketosis, free fatty acids and glucose synthesis (gluconeogenesis) fuel the remainder. Longer-term ketosis may result from fasting or staying on a low-carbohydrate diet (ketogenic diet), and deliberately induced ketosis serves as a medical intervention for various conditions, such as intractable epilepsy, and the various types of diabetes.[6] In glycolysis, higher levels of insulin promote storage of body fat and block release of fat from adipose tissues, while in ketosis, fat reserves are readily released and consumed.[5][7] For this reason, ketosis is sometimes referred to as the body's "fat burning" mode.[8] Ketosis and ketoacidosis are similar, but ketoacidosis is an acute life-threatening state requiring prompt medical intervention while ketosis can be physiological. However, there are situations (such as treatment-resistant Continue reading >>
In Defense Of Fasting: Common Misconceptions
Clearing misconceptions For those of you wondering, the tone of this article has been highly edited from my anger-rant earlier. I used my blog as catharsis, but now it’s back to business. I get a message across better being polite anyway. Fasting is a fairly unique diet technique. It’s at a crossroads (more like highway junction) of efficacy, health, social perception, eating disorders, and overall safety. It’s not bad given you avoid a few pitfalls and don’t blatantly starve yourself, but some people are still caught up in the midst of all this confusion, not knowing whether not eating for a single day will hurt them or help them. This article is subject to editing in the future. I am using this to keep tabs on the current science of fasting, both good and bad. It might be nice to keep it bookmarked and come back to it from time to time. I also suspect some time in the future it might become Tl;Dr, but a valuable tool nonetheless. This can be used in drug testing also and because of this some people have found a way to access synthetic urine. One of the most popular sites is Since fasting is put on ‘trail’ a lot, I figured I might bring up the common arguments like a court case. Just for kicks. Exhibit A: Ketosis and Ketoacidosis First, definitions: Ketosis is the state of an organism characterized by elevated serum levels of ketones Ketoacidosis is a metabolic state characterized by uncontrolled production of ketone bodies and decreased serum pH Ketosis is the presence of ketones, ketoacidosis is the presence of ketones combined with a drop in pH. The drop in pH is due in part to overproduction of ketones (which are acidic in nature) and a failure of the body/diet to buffer said acidity. So from this, we can preliminarily conclude that ketoacidosis will ki Continue reading >>
Longer Fasts, Ketoacidosis And Weight Regain
Longer fasts, ketoacidosis and weight regain There are tons of questions about intermittent fasting , like these Should you expect to regain some of the weight lost after breaking a long fast? Ketones tend to go up during longer fasts is there a risk of ketoacidosis? Dr. Jason Fung is one of the worlds leading experts on fasting for weight loss or diabetes reversal . Here are a his answers to those questions and more: Im not diabetic and Im not on any medications. Im now 5.5 days into my 7-day fast and I feel great! Ive been monitoring my blood sugar and ketone levels every 12 hours. Over the 5.5 days my blood sugar average is 81 and my ketone average is 4.1. This morning my blood sugar was 66 and ketones 5.4. I dont think I should be concerned about ketoacidosis but I cant help it, as my ketones get progressively higher I cant stop thinking about it. Please put my concerns to rest Is there any risk of my ketones going too high if Im NOT a type 1 diabetic? I have been at a weight loss plateau for months even while eating strict LCHF and following a 16:8 eating plan. In the 5.5 days of fasting Im down 7 lbs! In your weight loss management program, do you find clients are able to keep the weight off (after a long fast) when going back to an LCHF eating plan? Ketoacidosis mostly happens in type 1. Ketones are supposed to go up during fasting its called starvation ketosis. There will usually be some weight regain after the fast, so be prepared. Generally, you can expect to lose 1/2 pound per day of fasting on average. For 7 days, thats 3 1/2 pounds. Everything else could be water weight which will come back, and it would still be OK. It doesnt mean the fast didnt work. I just started fasting after reading your blog post series. Ive never tested blood glucose before and tho Continue reading >>
Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation
Ketoacidosis in a non-diabetic woman who was fasting during lactation 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 3German Center for Diabetes Research (DZD e.V.), Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 3German Center for Diabetes Research (DZD e.V.), Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 3German Center for Diabetes Research (DZD e.V.), Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chem Continue reading >>
Ketosis Vs. Ketoacidosis: What You Should Know
Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>
