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How To Induce Ketoacidosis

Ketoacidosis

Ketoacidosis

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 by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover.[2] Ketosis may also give off an odor, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Cause[edit] Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively.[3] In diabetic ketoacidosis, a high concentration of ketone bodies is usually accomp Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. 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 >>

Which Foods Increase Blood Acidity?

Which Foods Increase Blood Acidity?

Before Having Your Tonsils Removed Tonsillectomies are performed under general anesthesia. You will be completely asleep and will not be able to feel pain during the procedure. You will not be able to eat before surgery. This is because there is a risk of vomiting with anesthesia. Your physician or nurse will give you exact instructions about when to stop eating and drinking. In addition to not eating or drinking, you should not smoke, chew gum, or suck on mints or candy. Tonsillectomies are mostly performed in same day surgery settings. This means that you will go home the same day that you have your tonsils removed. You should wear loose comfortable clothing to the surgical center. Arrive on time. In some cases a medication called Versed can be given prior to the procedure to reduce anxiety, especially in small children. If you have other health problems, your doctor may order blood work or other tests before the surgery. If you are a woman of childbearing age (usually age 12 to 55 unless you have had a hysterectomy), it is mandatory that you have a pregnancy test before the surgery. This requires a small amount of urine. If the patient is a child and has a comfort item, such as a blanket or a favorite toy, bring it with you. Also, if your child drinks from a bottle or special cup, bring it along so your child can drink after the surgery. Make sure you bring comfortable clothing and extra diapers or underwear. Prior to having your tonsils removed, you will need to remove any metal from your body, including jewelry, retainers or body piercings. You will also need to remove contact lenses, dentures, and hearing aids. You will also need to refrain from medications that have the ability to thin your blood for one to two weeks before surgery. These medications include aspi Continue reading >>

What Are The Main Differences Between Nutritional Ketosis, And Ketosis?

What Are The Main Differences Between Nutritional Ketosis, And Ketosis?

I believe these can be used interchangeably. Ketosis is ketosis - this term describes a metabolic state characterized by elevated level of ketone bodies in your blood and low blood glucose levels, induced either by consumption of exogenous ketones or medium-chain triglycerides that are quickly metabolized into ketones, or by starvation (or, at least, restriction of carbohydrates), which switches your body’s metabolic machinery to utilizing fat oxidation as the main source of energy (byproducts of fat oxidation in the absence of glucose are then metabolized further into ketone bodies that can be used as energy substrate by most tissues). “Nutritional ketosis” is more often used to describe a voluntary exercise of inducing ketosis through certain dietary practices (in other words, this is ketosis as a result of a specific nutrition). But, given that nutrition (or lack thereof) still remains a primary method of inducing ketosis (barring direct consumptino of ketone esters, etc.) - most of the time, any ketosis is nutritional ketosis. Continue reading >>

Diabetic Ketoacidosis (dka) - Topic Overview

Diabetic Ketoacidosis (dka) - Topic Overview

Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine. Because the cells cannot receive sugar for energy, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis. Ketoacidosis can be caused by not getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes but it can happen with type 2 diabetes, especially children) when their blood sugar levels are high. Your blood sugar may be quite high before you notice symptoms, which include: Flushed, hot, dry skin. Feeling thirsty and urinating a lot. Drowsiness or difficulty waking up. Young children may lack interest in their normal activities. Rapid, deep breathing. A strong, fruity breath odor. Loss of appetite, belly pain, and vomiting. Confusion. Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips nearby in case your blood sugar level becomes high. When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through your vein and closely watching certain chemicals in your blood (electrolyt Continue reading >>

Would You Recommend The Ketogenic Diet To An 18 Year Old Girl For Weight Loss?

Would You Recommend The Ketogenic Diet To An 18 Year Old Girl For Weight Loss?

I’ve been on the diet for about 6 months. I am now 18 years old. The thing about Keto is that it’s a difficult diet and requires dedication, but the results are admirable. I’ve lost about 40 pounds over the course of the first 4 months and am now at 132 pounds, exercising once a week for an hour at best. I’ll give you the info you actually need to know, and then the rest will be my response to Sally’s post :) Also, remember that most people who give advice about weight loss have never been obese or overweight to a significant degree. Weight loss is a struggle and a battle, and you cannot rely on people who only criticize from afar. Would a soldier take advice on how to shoot a rifle from a civilian who has played Call of Duty? No? Thought not. Pros: Most people on keto do not need to consciously restrict food intake, you should never feel hungry. Generally preserves muscle mass and maximizes fat loss. You can eat fat again! Do not be afraid of fat. The fattiest animals, ruminants, consume low fat, grain based diets high in fiber. In contrast, every carnivore preferentially eats the fattiest part of the animal, yet they are lean. Why in the world would we assume that humans would get fat off of fat, when we have hundreds of contradictory examples in nature? Lots of natural substitutes for carb based foods available now, Low Carb Tortillas, Ice Creams, you name it. Watch for artificial sweeteners though. Not wholly reliant on exercise for weight loss, but it’s good for personal sanity to do so. Frees you from sugar addiction Cons: No carbs. It’s for life, you don’t “leave it.” It is not a “fad diet” that you do for 2 months and stop, it’s a lifestyle change and an approach to appreciate food. Don’t think of it as a thing that you can have cheat Continue reading >>

Original Communication Postmortem Biochemistry In Suspected Starvation-induced Ketoacidosis

Original Communication Postmortem Biochemistry In Suspected Starvation-induced Ketoacidosis

Highlights • Starvation ketoacidosis is a rare cause of metabolic acidosis. • The levels of ketonemia in starvation ketoacidosis is usually mild. • Starvation-ketoacidosis has been rarely described in the forensic setting. • The role that hyperketonemia may play in the death process should be evaluated. Significantly increased blood ketone body levels can be occasionally observed in the forensic setting in situations other than exposure to cold, diabetic or alcoholic ketoacidosis. Though infrequent, these cases do occur and deserve thorough evaluation in order to establish appropriate differential diagnoses and quantify the role that hyperketonemia may play in the death process. Starvation ketoacidosis is a rare cause of metabolic acidosis and is a phenomenon that occurs normally during fasting, as the body switches from carbohydrate to lipid energy sources. The levels of ketonemia in starvation ketoacidosis is usually mild in comparison to those seen in diabetic or alcoholic ketoacidosis. In the clinical setting, several cases of starvation-induced ketoacidosis mainly associated with gastric banding, pregnancy, malnutrition and low-carbohydrate diets have been reported. However, starvation ketosis causing severe metabolic acidosis has been rarely described in the medical literature. In the realm of forensic pathology, starvation-induced hyperketonemia has been rarely described. In this paper we present the postmortem biochemical results observed in situations of suspected starvation-induced hyperketonemia that underwent medico-legal examination. In all these cases, the diagnosis of starvation induced-hyperketonemia and the subsequent ketoacidosis was established per exclusionem based on all postmortem investigation findings. A review of the literature pertainin Continue reading >>

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

Diabetic ketoacidosis is a serious metabolic complication of diabetes with high mortality if undetected. Its occurrence in pregnancy compromises both the fetus and the mother profoundly. Although predictably more common in patients with type 1 diabetes, it has been recognised in those with type 2 diabetes as well as gestational diabetes, especially with the use of corticosteroids for fetal lung maturity and β2-agonists for tocolysis.1–3 Diabetic ketoacidosis usually occurs in the second and third trimesters because of increased insulin resistance, and is also seen in newly presenting type 1 diabetes patients. With increasing practice of antepartum diabetes screening and the availability of early and frequent prenatal care/surveillance, the incidence and outcomes of diabetic ketoacidosis in pregnancy have vastly improved. However, it still remains a major clinical problem in pregnancy since it tends to occur at lower blood glucose levels and more rapidly than in non-pregnant patients often causing delay in the diagnosis. The purpose of this article is to illustrate a typical patient who may present with diabetic ketoacidosis in pregnancy and review the literature on this relatively uncommon condition and provide an insight into the pathophysiology and management. MAGNITUDE OF THE PROBLEM In non-pregnant patients with type 1 diabetes, the incidence of diabetic ketoacidosis is about 1–5 episodes per 100 per year with mortality averaging 5%–10%.4 The incidence rates of diabetic ketoacidosis in pregnancy and the corresponding fetal mortality rates from different retrospective studies5–8 are summarised in the table 1. As is evident from the table, both the incidence and rates of fetal loss in pregnancies have fallen in recent times compared with those before. In 1963 Continue reading >>

Diabetic Ketoacidosis - Symptoms

Diabetic Ketoacidosis - Symptoms

A A A Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy. Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. The most common Continue reading >>

Steroid Induced Diabetic Ketoacidosis (dka) In A 13 Year Old Female With Renal Disorder

Steroid Induced Diabetic Ketoacidosis (dka) In A 13 Year Old Female With Renal Disorder

1Department of Paediatrics and Child Health, Faculty of Clinical Sciences, College of Health Sciences, University of Port Harcourt, Nigeria 2University of Port Harcourt Teaching Hospital, Nigeria *Corresponding Author: Department of Paediatrics University of Port Harcourt Teaching Hospital Port Harcourt, Rivers State, Nigeria E-mail: [email protected] Citation: Jaja T, Anochie IC, Eke FU (2012) Steroid Induced Diabetic Ketoacidosis (DKA) in a 13 year Old Female with Renal Disorder. Pediatr Therapeut 2:109. doi:10.4172/2161-0665.1000109 Copyright: © 2012 Jaja T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Pediatrics & Therapeutics Abstract Background: Diabetic ketoacidosis (DKA) is a common complication of poorly controlled diabetes mellitus in children and a rare complication of steroid therapy. Patients on steroid therapy may develop hyperglycemia as a complication, but presentation with DKA is rather unusual. Aim: To highlight a rare clinical entity of DKA induced by prednisolone in a 13 year old female on treatment for nephrotic syndrome. Case report: NC was a 13 year old female who presented with first episode of generalized body swelling, oliguria, massive proteinuria and hypercholesterolenaemia with normal renal function. She was not a known diabetic and had no family history of diabetes mellitus. She was started on prednisolone at 20 mg three times daily for nephrotic syndrome. Two weeks after commencement of prednisolone, she developed DKA with blood glucose of 31.1 mmol/l, glycosuria and ketonuria. She received intravenous in Continue reading >>

Pancreatic Ketoacidosis (kabadi Syndrome): Ketoacidosis Induced By High Circulating Lipase In Acute Pancreatitis

Pancreatic Ketoacidosis (kabadi Syndrome): Ketoacidosis Induced By High Circulating Lipase In Acute Pancreatitis

Broadlawns Medical Center, Des Moines University, Des Moines, Iowa and University of Iowa, Iowa City, Iowa, USA. *Corresponding Author: 17185, Berkshire Parkway Clive, Iowa, 50325, USA Phone +5152823041 E-mail [email protected] Visit for more related articles at JOP. Journal of the Pancreas Abstract Introduction Ketoacidosis is well established as a metabolic complication of both type 1 and type 2 diabetes Mellitus (Diabetic Ketoacidosis). It is often an initial presentation of type 1 diabetes in children and adolescents and occasionally in adults. Alternatively, it is induced of an onset of an acute disorder, e. g, sepsis, myocardial infarction, stroke, pregnancy etc. in subjects with type 1 and 2 diabetes. Ketoacidosis is also known to occur following an ethanol binge (Alcoholic Ketoacidosis). Finally, ketonemia with a rare progression to Ketoacidosis is documented to ensue following prolonged starvation. Methods The review of English literature for over 35 years from 01/1980 till 12/2015 for terms, 'ketonemia, ketonuria and ketoacidosis' 'pancreatic lipase' and 'acute pancreatitis'. Results 1) Description of individual patients presented as case reports, 2) Documentation of a series of consecutive subjects hospitalized for management of acute pancreatitis with special attention to establishing the prevalence of the disorder as well as examining the relationship between the severity of the disorder and occurrence of Ketoacidosis, 3) Studies demonstrating the relationship between progressively rising circulating pancreatic lipase concentrations with ketonuria, ketonemia and Ketoacidosis in subjects presenting with acute pancreatitis irrespective of the etiology and documenting resolution of ketonuria, ketonemia and ketoacidosis following the declining serum lipase leve Continue reading >>

Ketoacidosis In Diabetic Pregnancy

Ketoacidosis In Diabetic Pregnancy

Diabetic ketoacidosis (DKA) is a serious medical and obstetrical emergency previously considered typical of type 1 diabetes but now reported also in type 2 and GDM patients. Although it is a fairly rare condition, DKA in pregnancy can compromise both fetus and mother. Metabolic changes occurring during pregnancy predispose to DKA in fact it can develop even in setting of normoglycemia. This article will provide the reader with information regarding the pathophysiology underlying DKA, in particular euglycemic DKA, and will provide information regarding all possible effects of ketones on the fetus. Continue reading >>

Diabetic Ketoacidosis Inducing Myocardial Infarction Secondary To Treatment With Dapagliflozin: A Case Report

Diabetic Ketoacidosis Inducing Myocardial Infarction Secondary To Treatment With Dapagliflozin: A Case Report

Go to: Case Report A 58‐year‐old male with dyslipidemia, an eight‐year history of T2DM, a family history, his mother, of T2DM, with no known micro‐ or macrovascular complications, was admitted to the emergency department for malaise, epigastric pain, polyuria, and progressive dyspnea which had begun 10 h ago. He had experienced a 2‐kg weight loss over the last few days. His usual medications included aspirin 100 mg q24 h, atorvastatin 40 mg q24 h, and metformin 850 mg q8 h, which had been switched to dapagliflozin 20 days before, due to poor glycemic control, with HbA1c 12% (108 mmol/mol). His vital signs included a heart rate of 122 bpm, respiratory rate 33 rpm, blood pressure 142/70 mmHg, temperature 36.1°C, and body mass index 22.5 kg/m2. On physical examination, somnolence, dry skin and mucous membranes, a Kussmaul breathing pattern, and a capillary refill of 3 sec were observed. Blood tests revealed hemoglobin 17.1 g/dL (13.5–18), leukocytes 19.5 × 103 (4–10 × 103), platelets 296 × 103 (150–450 × 103), glucose 248 mg/dL (60–100), creatinine 0.97 mg/dL (0.67–1.17), sodium 136 mmol/L (135–145), potassium 4.7 mmol/L (3.5–5.5), chloride 101 mmol/L (95–112), phosphate 4.9 mg/dL (2.5–4.5), amylase 70 U/L (10–115), lipase 28 U/L (1–67), pH 6.95 (7.35–7.45), pCO2 23 mmHg (35–45), HCO3 5 mmol/L (22–26), lactate 1.8 mmol/L (0–1.5), urine ketone bodies >150 mg/dL (0–0), CK 112 U/L (1–190), CK‐MB 7.3 ng/mL (0.1–5), and troponin I 0.07 ng/mL (0.001–0.05). The electrocardiogram (EKG) showed sinus rhythm with right bundle branch block, and nonspecific repolarization abnormalities. Because of the right bundle branch block was not previously known, a new troponin test was performed six hours later with a peak value of 4.28 ng/m Continue reading >>

Complete Resolution Of Olanzapine-induced Diabetic Ketoacidosis

Complete Resolution Of Olanzapine-induced Diabetic Ketoacidosis

We report the case of a nondiabetic man who developed diabetic ketoacidosis associated with high-dose olanzapine. Olanzapine has been associated with diabetic ketoacidosis and also with weight gain, lipid abnormalities, and the development of type 2 diabetes. This case is of interest both because of the sudden onset and because the patient's blood glucose stabilized 1 month after discontinuation of olanzapine, thus allowing insulin therapy to be discontinued. The patient has now been stabilized on ziprasidone with no further abnormalities in blood glucose. Continue reading >>

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