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Fasting Ketoacidosis Treatment

The Difference Between Ketosis And Ketoacidosis

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 >>

Normoglycemic Diabetic Ketoacidosis In Pregnancy

Normoglycemic Diabetic Ketoacidosis In Pregnancy

The clinical presentation of diabetic ketoacidosis in pregnancy is usually the same as in nonpregnant women, although the blood glucose may not be as high as in the nongravid state. We report a case of a pregnant woman who developed diabetic ketoacidosis with a normal blood glucose and review the pertinent medical literature. A 29-year-old woman with type I diabetes developed diabetic ketoacidosis during induction of labor. She had a glucose level of 87 mg per 100 ml with ketonuria, a metabolic acidosis, and an anion gap of 20 mmol l−1. Normoglycemic diabetic ketoacidosis during pregnancy is truly unusual but can occur with relatively low, or even normal, blood sugars and necessitates prompt recognition and treatment. In this case, the combination of an initial episode of hypoglycemia and subsequent blood glucose levels below 95 mg per 100 ml led to a prolonged delay in the initiation of a planned insulin infusion for insulin coverage during the induction of labor. A significant ketoacidosis consequently developed, despite the absence of even a single elevated blood glucose measurement. This case illustrated the importance of not withholding insulin in a patient with type I diabetes for more than a few hours even if the blood glucose is normal. Normal pregnancy is characterized by a state of decreased insulin sensitivity, as well as accelerated lipolysis and ketogenesis.1, 2, 3, 4 The concentration of serum ketones has been estimated to be two to four times greater than in the nonpregnant state.1, 5 In addition, pregnant women have a respiratory alkalosis, lowering the serum bicarbonate concentration, thus reducing the capacity to buffer hydrogen ions. Despite these changes, the incidence of diabetic ketoacidosis (DKA) in pregnant diabetic women is only 1 to 3%.6, 7 K Continue reading >>

Extreme Gestational Starvation Ketoacidosis: Case Report And Review Of Pathophysiology

Extreme Gestational Starvation Ketoacidosis: Case Report And Review Of Pathophysiology

A case of severe starvation ketoacidosis developing during pregnancy is presented. The insulinopenic/insulinresistant state found during fasting in late gestation predisposes to ketosis. Superimposition of stress hormones, which further augment lipolysis, exacerbates the degree of ketoacidosis. In our patient, gestational diabetes, twin pregnancies, preterm labor, and occult infection were factors that contributed to severe starvation ketoacidosis. Diagnosis was delayed because starvation ketosis is not generally considered to be a cause of severe acidosis, and because the anion gap was not elevated. Improved understanding of the complex fuel metabolism during pregnancy should aid in prevention, early recognition, and appropriate therapy of this condition. Continue reading >>

Ketosis Vs. Ketoacidosis: What You Should Know

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 >>

Diabetes, Surgery And Medical Illness

Diabetes, Surgery And Medical Illness

Peri-operative management of blood-glucose concentrations depends on factors including the required duration of fasting, timing of surgery (morning or afternoon), usual treatment regimen (insulin, antidiabetic drugs or diet), prior glycaemic control, other co-morbidities, and the likelihood that the patient will be capable of self-managing their diabetes in the immediate post-operative period. All patients should have emergency treatment for hypoglycaemia written on their drug chart on admission. Note: The following recommendations provide general guidance for the management of diabetes during surgery. Local protocols and guidelines should be followed where they exist. Elective surgeryminor procedures in patients with good glycaemic control Patients usually treated with insulin who have good glycaemic control (HbA1c less than 69mmol/mol or 8.5%) and are undergoing minor procedures, can be managed during the operative period by adjustment of their usual insulin regimen, which should be adjusted depending on the type of insulin usually prescribed, following detailed local protocols (which should also include intravenous fluid management, monitoring and control of electrolytes and avoidance of hyperchloraemic metabolic acidosis). On the day before the surgery, the patients usual insulin should be given as normal, other than once daily long-acting insulin analogues, which should be given at a dose reduced by 20%. Elective surgerymajor procedures or poor glycaemic control Patients usually treated with insulin, who are either undergoing major procedures (surgery requiring a long fasting period of more than one missed meal) or whose diabetes is poorly controlled, will usually require a variable rate intravenous insulin infusion (continued until the patient is eating/drinking Continue reading >>

Fasting May Improve Cancer Treatment, But Needs Further Exploration

Fasting May Improve Cancer Treatment, But Needs Further Exploration

The gold standard treatment for cancer in the last few decades has been a combination of surgery – to remove tumours – and chemotherapy and radiotherapy – to kill cancer cells. With the progress of personalised medicine, where identifying specific mutations in the tumour guides treatment selection, there has been increasing success in survival rates. But there has been little improvement in reducing side effects on healthy cells caused by chemotherapy, which also limit the dosage that can be administered. Over the last two decades, research in animals has shown restricting calories - with alternating periods of fasting and feeding – promotes protection mechanisms for healthy cells, while increasing white blood cells that kill cancer cells. A 2008 study showed mice with neuroblastoma, a common childhood cancer, that had only water for two days before receiving a large dose of chemotherapy, experienced less or no side effects compared to mice fed normally. In another study, tumour cells were killed more efficiently in mice who weren’t fed than in those that were. Since then, further animal studies and early trials in humans confirmed short-term fasting prior to, and after, chemotherapy treatment reduced side effects. It also protected healthy cells from the toxicity of the drug, while killing cancerous ones. So does this mean we can use fasting to help with cancer treatment? Glucose and cancer Cancerous cells are known to rely on glucose, a type of sugar, for their energy metabolism, rapid growth, and resistance to chemotherapy. That cancer cells thrive on glucose was first shown by German physiologist Otto Warburg in the 1950s. He also showed they were unable to use fatty acids as efficiently for energy, or at all. This idea of cancer being a disease reliant on Continue reading >>

Dom D’agostino On Fasting, Ketosis, And The End Of Cancer

Dom D’agostino On Fasting, Ketosis, And The End Of Cancer

Dr. Dominic “Dom” D’Agostino (@DominicDAgosti2) is an Assistant Professor in the Department of Molecular Pharmacology and Physiology at the University of South Florida Morsani College of Medicine, and a Senior Research Scientist at the Institute for Human and Machine Cognition (IHMC). He has also deadlifted 500 pounds for 10 reps after a seven-day fast. He’s a beast and — no big surprise — he’s a good buddy of Dr. Peter Attia, my MD friend who drinks “jet fuel” in search of optimal athletic performance. The primary focus of Dom’s laboratory is developing and testing metabolic therapies, including ketogenic diets, ketone esters and ketone supplements to induce nutritional/therapeutic ketosis. D’Agostino’s laboratory uses in vivo and in vitro techniques to understand the physiological, cellular and molecular mechanism of metabolic therapies and nutritional strategies for peak performance and resilience. His research is supported by the Office of Naval Research (ONR), Department of Defense (DoD), private organizations and foundations. Want to hear another podcast discussing ketosis from a world class scientist? — Listen to my conversation with Dr. Peter Attia. In this episode, we discuss life-extension, drinking jet fuel, ultra-endurance, human foie gras, and more (stream below or right-click here to download): All you need to do to get your free audiobook and a free 30-day trial is go to Audible.com/tim. Choose one of the above books, or choose between more than 180,000 audio programs. That could be a book, a newspaper, a magazine or even a class. It’s that easy. Go to Audible.com/Tim and get started today. Enjoy! This podcast is also brought to you by 99Designs, the world’s largest marketplace of graphic designers. I have used them for years Continue reading >>

Inadequate Treatment Causing Fasting Ketoacidosis In A Patient With Addisonian Crisis

Inadequate Treatment Causing Fasting Ketoacidosis In A Patient With Addisonian Crisis

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Are There Different Types Of Ketosis?

Are There Different Types Of Ketosis?

Before reading this, if you haven’t already, I suggest reading What is a Ketogenic Diet and Understanding Ketosis so you will have a stronger understanding of what it means to be in a state of ketosis. The next step necessary in comprehending the ketogenic diet is learning the different types of ketosis that can occur. For this article, we will refer to three different forms of ketosis: fasting ketosis, nutritional ketosis, and pathological ketosis. The different types of ketosis vary in their degree of ketone production as well as their method of induction. Fasting Ketosis The idea of fasting has been around for hundreds of years and played a major part in the origins of the ketogenic diet. In fact, many great philosophers, such as Hippocrates, Socrates, and Aristotle, all praised the many benefits of fasting. Paracelsus, physician and father of toxicology, was quoted saying, “Fasting is the greatest remedy—the physician within.” While these early scientists and philosophers were definitely ahead of the game in recognizing the potential of fasting, the mechanisms were still yet to be understood. Ketosis tends to occur when insulin and blood glucose levels decrease to an extent that allows for increased fat oxidation, which is ultimately followed by greater ketone production. A minor state of ketosis can occur following periods of complete food restriction, such as an overnight fast. This may produce ketone levels around 0.1 mmol/L to 0.03 mmol/L. Shorter duration fasts typically will not raise ketone levels above these levels because the rate of ketone metabolism matches ketone synthesis. As the fast continues, the rate of ketone production exceeds ketone clearance, resulting in an increase in blood ketone levels (1). While a minor state of ketosis can occur du Continue reading >>

The Perks Of Fasting, With None Of The Work

The Perks Of Fasting, With None Of The Work

“If there’s a downside, it is kind of crazy tasting,” said Geoff Woo, the founder of HVMN, a Silicon Valley company that makes nootropics, or performance-enhancing supplements. We were in a conference room in The Atlantic’s office building, and he was bracing me for my trial run of his latest product. It was a small, clear vial labeled “Ketone,” a new type of energy drink his company is releasing this week. Its nutrition label says it contains 120 calories, but no carbs, no fat, and no protein. Instead, it’s all ketones, the chemical that Woo and his company are calling a “fourth food group.” He hopes the drink will allow people to reap the benefits of occasional fasting—high ketone levels inside the body—without actually having to not eat. I unscrewed the top and, college-days muscle memory kicking in, chugged it like a shot of Captain Morgan. It tasted like cough syrup that had been poured into a garbage bag and left in the sun. “Augh!” I cried. “I compare it to a combination of a liquor shot with nail-polish remover,” Woo said. Woo’s coworker, Brianna Stubbs, went to fetch me a glass of water. “We’ve done a lot of work to make it better,” she said. Within an hour, the drink was supposed to help improve my athletic performance by changing how my body burned energy during exercise. Some people also say it helps them feel more energetic and focused on their work. About 25 minutes after I drank Ketone, Woo and Stubbs pricked my finger to see if it was working. My blood sugar, which had verged on diabetic levels from some pineapple I had eaten that morning, was down to near-normal levels. Meanwhile, my ketones, which had been practically nonexistent before imbibing—measuring just 0.2 millimolar—had soared to 4.9. “It would have Continue reading >>

Ketoacidosis During A Low-carbohydrate Diet

Ketoacidosis During A Low-carbohydrate Diet

To the Editor: It is believed that low-carbohydrate diets work best in reducing weight when producing ketosis.1 We report on a 51-year-old white woman who does not have diabetes but had ketoacidosis while consuming a “no-carbohydrate” diet. There was no family history of diabetes, and she was not currently taking any medications. While adhering to a regimen of carbohydrate restriction, she reached a stable weight of 59.1 kg, a decrease from 72.7 kg. After several months of stable weight, she was admitted to the hospital four times with vomiting but without abdominal pain. On each occasion, she reported no alcohol use. Her body-mass index (the weight in kilograms divided by the square of the height in meters) was 26.7 before the weight loss and 21.7 afterward. Laboratory evaluation showed anion-gap acidosis, ketonuria, and elevated plasma glucose concentrations on three of the four occasions (Table 1). She had normal concentrations of plasma lactate and glycosylated hemoglobin. Screening for drugs, including ethyl alcohol and ethylene glycol, was negative. Abdominal ultrasonography showed hepatic steatosis. On each occasion, the patient recovered after administration of intravenous fluids and insulin, was prescribed insulin injections on discharge, and gradually reduced the use of insulin and then discontinued it while remaining euglycemic for six months or more between episodes. Testing for antibodies against glutamic acid decarboxylase and antinuclear antibodies was negative. Values on lipid studies were as follows: serum triglycerides, 102 mg per deciliter; high-density lipoprotein (HDL) cholesterol, 50 mg per deciliter; and calculated low-density lipoprotein (LDL) cholesterol, 189 mg per deciliter. The patient strictly adhered to a low-carbohydrate diet for four Continue reading >>

Euglycemic Diabetic Ketoacidosis: An Easily Missed Diagnosis

Euglycemic Diabetic Ketoacidosis: An Easily Missed Diagnosis

SESSION TITLE: Critical Care Student/Resident Case Report Posters I SESSION TYPE: Student/Resident Case Report Poster INTRODUCTION: A 47 year-old woman with type 1 diabetes presented with euglycemic diabetic ketoacidosis (DKA) that initially went undiagnosed. Recognition and treatment with insulin resulted in rapid resolution of her clinical condition. CASE PRESENTATION: A 47 year-old woman presented to our hospital with four days of fever, abdominal pain, diarrhea, nausea, vomiting, lethargy and malaise. She had a history of type 1 diabetes mellitus managed with an insulin pump. Her blood pressure was 88/51. She was disoriented with a diffusely tender but soft abdomen. Laboratory studies revealed blood glucose of 109 mg/dL, bicarbonate of 15 mmol/L, anion gap of 27 mmol/L, lactic acid of 2.4 mmol/L, and a bandemia of 11%. Rapid flu test was positive. She was admitted to the intensive care unit, resuscitated with intravenous fluid, and started on oseltamivir, cefepime and vancomycin. Hemodialysis was initiated soon thereafter. The patient received no insulin due to her euglycemia. Influenza A was detected by PCR on the second hospital day and antibiotics were discontinued. Her gastrointestinal symptoms improved but her mental status remained poor. Furthermore, while her lactate normalized and blood glucose remained under 120 mg/d, her anion gap persisted at 23-36 mmol/L and her bicarbonate remained low at 15-17 mmol/L. Beta hydroxybutyrate was found to be 4.88 mmol/L. An insulin infusion was started, along with dextrose 5% in water, and her mental status rapidly improved as her acidemia and anion gap normalized. DISCUSSION: Euglycemic DKA is a rare condition that can easily go undiagnosed. It has been previously described in the context of critical illness.1 The pathoge Continue reading >>

Ketoacidosis: A Complication Of Diabetes

Ketoacidosis: A Complication Of Diabetes

Diabetic ketoacidosis is a serious condition that can occur as a complication of diabetes. People with diabetic ketoacidosis (DKA) have high blood sugar levels and a build-up of chemicals called ketones in the body that makes the blood more acidic than usual. Diabetic ketoacidosis can develop when there isn’t enough insulin in the body for it to use sugars for energy, so it starts to use fat as a fuel instead. When fat is broken down to make energy, ketones are made in the body as a by-product. Ketones are harmful to the body, and diabetic ketoacidosis can be life-threatening. Fortunately, treatment is available and is usually successful. Symptoms Ketoacidosis usually develops gradually over hours or days. Symptoms of diabetic ketoacidosis may include: excessive thirst; increased urination; tiredness or weakness; a flushed appearance, with hot dry skin; nausea and vomiting; dehydration; restlessness, discomfort and agitation; fruity or acetone smelling breath (like nail polish remover); abdominal pain; deep or rapid breathing; low blood pressure (hypotension) due to dehydration; and confusion and coma. See your doctor as soon as possible or seek emergency treatment if you develop symptoms of ketoacidosis. Who is at risk of diabetic ketoacidosis? Diabetic ketoacidosis usually occurs in people with type 1 diabetes. It rarely affects people with type 2 diabetes. DKA may be the first indication that a person has type 1 diabetes. It can also affect people with known diabetes who are not getting enough insulin to meet their needs, either due to insufficient insulin or increased needs. Ketoacidosis most often happens when people with diabetes: do not get enough insulin due to missed or incorrect doses of insulin or problems with their insulin pump; have an infection or illne Continue reading >>

Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Copyright © 2014 Nupur Sinha et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pregnancy is a diabetogenic state characterized by relative insulin resistance, enhanced lipolysis, elevated free fatty acids and increased ketogenesis. In this setting, short period of starvation can precipitate ketoacidosis. This sequence of events is recognized as “accelerated starvation.” Metabolic acidosis during pregnancy may have adverse impact on fetal neural development including impaired intelligence and fetal demise. Short periods of starvation during pregnancy may present as severe anion gap metabolic acidosis (AGMA). We present a 41-year-old female in her 32nd week of pregnancy, admitted with severe AGMA with pH 7.16, anion gap 31, and bicarbonate of 5 mg/dL with normal lactate levels. She was intubated and accepted to medical intensive care unit. Urine and serum acetone were positive. Evaluation for all causes of AGMA was negative. The diagnosis of starvation ketoacidosis was established in absence of other causes of AGMA. Intravenous fluids, dextrose, thiamine, and folic acid were administered with resolution of acidosis, early extubation, and subsequent normal delivery of a healthy baby at full term. Rapid reversal of acidosis and favorable outcome are achieved with early administration of dextrose containing fluids. 1. Introduction A relative insulin deficient state has been well described in pregnancy. This is due to placentally derived hormones including glucagon, cortisol, and human placental lactogen which are increased in periods of stress [1]. The insulin resistance increases with gestational age Continue reading >>

Ketosis Fundamentals

Ketosis Fundamentals

What is ketosis? Ketosis is the physiological state where the concentration of ketone bodies in the blood is higher than normal. This is generally agreed to be at beta-hydroxybutyrate (BHB) concentrations greater than 0.5 mM. How to achieve ketosis? Ketosis occurs either as a result of increased fat oxidation, whilst fasting or following a strict ketosis diet plan (ENDOGENOUS ketosis), or after consuming a ketone supplement (EXOGENOUS ketosis). When in a state of ketosis the body can use ketones to provide a fuel for cellular respiration instead of its usual substrates: carbohydrate, fat or protein. Why does ketosis exist? Normally, the body breaks down carbohydrates, fat, and (sometimes) proteins to provide energy. When carbohydrate is consumed in the diet, some is used immediately to maintain blood glucose levels, and the rest is stored. The hormone that signals to cells to store carbohydrate is insulin. The liver stores carbohydrate as glycogen, this is broken down and released between meals to keep blood glucose levels constant. Muscles also store glycogen, when broken down this provides fuel for exercise. Most cells in the body can switch readily between using carbohydrates and fat as fuel. Fuel used depends on substrate availability, on the energy demands of the cell and other neural and hormonal signals. The brain is different as it is dependent on carbohydrates as a fuel source. This is because fats cannot easily cross the blood-brain barrier. The inability to make use of energy within fat poses a problem during periods where there is limited carbohydrate in the diet. If blood glucose levels fall to low, brain function declines. Relatively little energy is stored as carbohydrate (2,000 kCal) compared to fat (150,000 kCal). The body's store of carbohydrates runs Continue reading >>

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