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Fasting Ketoacidosis Treatment

Ketoacidosis

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 >>

The Emedicinehealth Doctors Ask About Diabetic Ketoacidosis:

The Emedicinehealth Doctors Ask About Diabetic Ketoacidosis:

A A A Diabetic Ketoacidosis (cont.) A person developing diabetic ketoacidosis may have one or more of these symptoms: excessive thirst or drinking lots of fluid, frequent urination, general weakness, vomiting, loss of appetite, confusion, abdominal pain, shortness of breath, a generally ill appearance, increased heart rate, low blood pressure, increased rate of breathing, and a distinctive fruity odor on the breath. If you have any form of diabetes, contact your doctor when you have very high blood sugars (generally more than 350 mg) or moderate elevations that do not respond to home treatment. At initial diagnosis your doctor should have provided you with specific rules for dosing your medication(s) and for checking your urinary ketone level whenever you become ill. If not, ask your health care practitioner to provide such "sick day rules." If you have diabetes and start vomiting, seek immediate medical attention. If you have diabetes and develop a fever, contact your health care practitioner. If you feel sick, check your urinary ketone levels with home test strips. If your urinary ketones are moderate or higher, contact your health care practitioner. People with diabetes should be taken to a hospital's emergency department if they appear significantly ill, dehydrated, confused, or very weak. Other reasons to seek immediate medical treatment include shortness of breath, chest pain, severe abdominal pain with vomiting, or high fever (above 101 F or 38.3 C). Continue Reading A A A Diabetic Ketoacidosis (cont.) The diagnosis of diabetic ketoacidosis is typically made after the health care practitioner obtains a history, performs a physical examination, and reviews the laboratory tests. Blood tests will be ordered to document the levels of sugar, potassium, sodium, and oth 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 >>

Severe Diabetic Ketoacidosis In Combination With Starvation And Anorexia Nervosa At Onset Of Type 1 Diabetes: A Case Report

Severe Diabetic Ketoacidosis In Combination With Starvation And Anorexia Nervosa At Onset Of Type 1 Diabetes: A Case Report

We here report a case of diabetic ketoacidosis at onset of type 1 diabetes after a prolonged period of starvation due to anorexia nervosa. A 53-year-old female with a history of anorexia nervosa was admitted to the psychiatric clinic due to psychotic behaviour and inability to take care of herself. Twenty-four hours after admission she was transferred to the clinic of internal medicine due to altered mental status, and laboratory screening revealed a pH of 6.895 and blood glucose concentration of 40 mmol/L. Due to the unusual combination of prolonged starvation and diabetic ketoacidosis we implemented some modifications of existing treatment guidelines and some special considerations regarding nutrition in order to prevent a re-feeding syndrome. Diabetic ketoacidosis (DKA) is a feared and potentially lethal complication in diabetic patients, with a 5% mortality rate. DKA is the cause of half of all deaths in individuals with type 1 diabetes (T1D) under the age of 24 (1) and is characterized by hyperglycaemia, acidosis, electrolyte changes, and dehydration due to hypoinsulinaemia (2), with the diagnostic criteria: ketonaemia >3 mmol/L; blood glucose >11 mmol/L, and venous bicarbonate <15 mmol/L and/or a venous pH <7.3 (3). Most cases of DKA occur due to an infection, trauma, pancreatitis, or poor medication compliance in patients with known diabetes, but T1D can also present as DKA (1). Another condition that causes an altered metabolism and metabolic acidosis is severe starvation where ketone bodies are produced as in DKA (4). However, starvation leads to hypoglycaemia, and the loss of fluid is therefore not as severe as in DKA. Patients with anorexia nervosa (AN) display several metabolic and endocrine changes including impaired glucose tolerance caused by long-standin Continue reading >>

An Unusual Cause For Ketoacidosis

An Unusual Cause For Ketoacidosis

Abstract Introduction In our continuing series on the application of principles of integrative physiology at the bedside, once again the central figure is an imaginary consultant, the renal and metabolic physiologist, Professor McCance, who deals with data from a real case. On this occasion his colleague Sir Hans Krebs, an expert in the field of glucose and energy metabolism, assists him in the analysis. Their emphasis is on concepts that depend on an understanding of physiology that crosses subspecialty boundaries. To avoid overwhelming the reader with details, key facts are provided, but only when necessary. The overall objective of this teaching exercise is to demonstrate how application of simple principles of integrative physiology at the bedside can be extremely helpful for clinical decision-making (Table 1). Principle Comment 1. A high H+ concentration per se is seldom life-threatening The threat to survival is usually due to the cause for the acidosis rather than the pH per se 2. Finding a new anion means a new acid was added Look in plasma (anion gap) and urine (net charge) to identify the new anions 3. Identify the acid by thinking of the properties of the anion Rate of production, rapidity of clearance from plasma, and unique toxic effects may all provide clues 4. Metabolic acidosis develops when the kidney fails to add new HCO3 to the body The kidney generates HCO3− by excreting NH4+, (usually with Cl−), in the urine 5. Ketoacids are brain fuels, produced when there is a prolonged lack of insulin The usual causes are diabetic ketoacidosis, alcoholic ketoacidosis, starvation or hypoglycemia-induced ketoacidosis, or that associated with salicylate overdose 6. Ketoacids are produced in the liver from acetyl-CoA, usually derived from fatty acids A low net in Continue reading >>

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 >>

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 >>

Ketosis

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 >>

Oral Glucose Intervention For Children With Gastroenteritis And Ketosis

Oral Glucose Intervention For Children With Gastroenteritis And Ketosis

Fasting ketoacidosis adds morbidity to children affected by gastrointestinal infections. The investigators investigate oral glucose gel for its effectiveness in rapidly reducing ketoacidosis and for improvements in oral hydration therapy success. More than 1.7 million children with acute gastroenteritis present for emergency department (ED) care annually in the United States. Gastroenteritis treatment regimens have been outlined in guidelines endorsed by the American Academy of Pediatrics, European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), and Center for Disease Control (CDC). A fundamental principle included in these guidelines is the administration of oral rehydration therapy (ORT) to the vast majority of children with gastroenteritis; however, surveys have shown that a gap exists between guidelines and practice. Fasting ketoacidosis is an increasingly recognized metabolic derangement for children presenting with symptoms suggestive of gastroenteritis and mild to moderate dehydration. Ketoacidosis frequently occurs and likely adds comorbid symptoms of lethargy, vomiting, and malaise. These symptoms likely impair successful oral rehydration interventions. These symptoms may also lead to overestimations of the severity of dehydration. Rapid recognition of ketoacidosis is now possible with point of care testing beta-hydroxybutyrate. This investigation will determine if an oral glucose gel intervention will improve the Point Of Care (POC) beta-hydroxybutyrate from baseline. Secondary outcomes measured will include net fluid volume intake estimates, need for IV hydration, and need for hospitalization. Study Type : Observational Estimated Enrollment : 500 participants Observational Model: Cohort Time Perspective: Prospective Official Title: O 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 >>

Ketosis: What Is Ketosis?

Ketosis: What Is Ketosis?

Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>

Starvation Ketoacidosis As A Cause Of Unexplained Metabolic Acidosis In The Perioperative Period

Starvation Ketoacidosis As A Cause Of Unexplained Metabolic Acidosis In The Perioperative Period

Go to: Abstract Patient: Female, 24 Final Diagnosis: Starvation ketoacidosis Symptoms: None Medication: — Clinical Procedure: Lumbar laminectomy Specialty: Orthopedics and Traumatology Besides providing anesthesia for surgery, the anesthesiologist’s role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient’s perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient’s surgical outcome. Thus, the presence of an acute acid-base disturbance requires a thorough workup, the results of which will influence the patient’s anesthetic management. An otherwise-healthy 24-year-old female presented for elective spine surgery and was found to have metabolic acidosis, hypotension, and polyuria intraoperatively. Common causes of acute metabolic acidosis were investigated and systematically ruled out, including lactic acidosis, diabetic ketoacidosis, drug-induced ketoacidosis, ingestion of toxic alcohols (e.g., methanol, ethylene glycol), uremia, and acute renal failure. Laboratory workup was remarkable only for elevated serum and urinary ketone levels, believed to be secondary to starvation ketoacidosis. Due to the patient’s unexplained acid-base disturbance, she was kept intubated postoperatively to allow for further workup and management. Starvation ketoacidosis is not widely recognized as a perioperative entity, and it is not well described in the medical literature. Lack of anesthesiologist awareness about this disorder may complicate the differential diagnosis for acute intraoperative metabolic acidosi Continue reading >>

Keep Yourself In Ketosis

Keep Yourself In Ketosis

When talking about a Grain Brain lifestyle, and the very similar ketogenic diet, it’s frequently mentioned that we are aiming to keep our bodies in ketosis. However, if you’re new to my work, it may be that you’re not exactly sure what ketosis is, or why we should be worrying about getting our body into this state. Allow me to explain. Ketones are a special type of fat that can stimulate the pathways that enhance the growth of new neural networks in the brain. A ketogenic diet is one that is high in fats, and this diet has been a tool of researchers for years, used notably in a 2005 study on Parkinson’s patients finding an improvement in symptoms after just 28 days. The improvements were on par with those made possible via medication and brain surgery. Other research has shown the ketogenic diet to be remarkably effective in treating some forms of epilepsy, and even brain tumors. Ketones do more than just that though. They increase glutathione, a powerful, brain-protective antioxidant. Ketones facilitate the production of mitochondria, one of the most important actors in the coordinated production that is the human body. And that’s just the tip of the iceberg. Our bodies are said to enter ketosis at the point when blood sugar levels are low and liver glycogen are no longer available to produce glucose as a fuel for cellular energy production. At this point, not only is the body doing the natural thing, and burning off fat, it’s also powering up the brain with a super efficient fuel. We can jump start ourselves into ketosis with a brief fast, allowing our body to quickly burn through the carbs that are in our system, and turn to fat for fuel. A ketogenic diet is one that derives around 80% or more of of its calories from fat, and the rest from carbs and prote Continue reading >>

Intermittent Fasting On A Keto Diet

Intermittent Fasting On A Keto Diet

Intermittent Fasting, or “IF”, is a relatively new craze that is used as a supplement to your diet. It revolves around the timing of your food intake, and can have some benefits in the long run. There are quite a few people misinformed on fasting, so we’ll clear that up and explain how intermittent fasting can be useful. On your ketogenic journey, it’s important to know that your success is not only dictated by eating enough fat and protein and restricting carbs. When you eat, how often you eat, and how much you eat have a substantial impact on your health and function as well. If your results have plateaued or you are thinking of starting a ketogenic diet, this article will provide you with a way to lose more fat and improve energy levels called intermittent fasting. If you need to learn how to calculate your macros, visit our Keto Calculator. Fasting isn’t required to lose weight on a ketogenic diet. If it doesn’t work for you, then do not force yourself to fast. Restricting yourself unrealistically is pointless – it’s not worth it if it makes you unhappy. There are 2 basic terms we need to understand here first: feeding and fasting. Your body is in a feeding state when you are eating your food, and you are in a fasting state when you are between your meals. The Approach Skipped meals. This is when you skip over a meal to induce extra time of fasting. Usually people choose breakfast, but others prefer to skip lunch. Eating windows. Usually this condenses your entire macronutrient intake between a 4 and 7 hour window. The rest of the time you are in a fasting state. 24-48 hour cleanse. This is where you go into extended fasting periods, and do not eat for 1-2 days. I don’t recommend that you go straight for a 1-2 day fast, but begin by restricting you Continue reading >>

Ketosis Explained – For Weight Loss, Health Or Performance

Ketosis Explained – For Weight Loss, Health Or Performance

Get Started Ketosis is a natural state for the body, when it is almost completely fueled by fat. This is normal during fasting, or when on a strict low-carb diet. Ketosis has many potential benefits, but there are also side effects. In type 1 diabetes and certain other rare situations excessive ketosis can even become dangerous. On this page you can learn all about how to harness the benefits of ketosis, while avoiding any problems. It all starts with understanding what ketosis is. Choose a section, or keep reading below for all of them. Ketosis ExplainedKetosis Explained BenefitsBenefits How to Get Into KetosisHow to Get Into Ketosis Ketosis ExplainedSymptoms & How to Know You’re In Ketosis Side Effects, Fears & Potential DangersSide Effects, Fears & Potential Dangers How to Reach Optimal KetosisHow to Reach Optimal Ketosis ketones Ketosis Explained The “keto” in the word ketosis comes from the fact that it makes the body produce small fuel molecules called “ketones”.1 This is an alternative fuel for the body, used when blood sugar (glucose) is in short supply. Ketones are produced if you eat very few carbs (that are broken down into blood sugar) and only moderate amounts of protein (excess protein can be converted to blood sugar). Ketones are produced in the liver, from fat. They are then consumed as fuel in the body, including by the brain. This is important as the brain is a hungry organ that consumes lots of energy every day,2 and it can’t run on fat directly. It can only run on glucose… or ketones. Maximizing fat burning On a ketogenic diet your entire body switches its fuel supply to run almost entirely on fat. Insulin levels become very low and fat burning increases dramatically. It becomes easy to access your fat stores to burn them off. This is o Continue reading >>

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