Acetone Metabolism During Diabetic Ketoacidosis.
Abstract The presence and the importance of acetone and its metabolism in diabetic ketoacidosis has largely been ignored. Therefore, we studied acetone metabolism in nine diabetic patients in moderate to severe ketoacidosis. The concentration of acetone in plasma, urine, and breath, and the rates of acetone production and elimination in breath and urine were determined and the rates of vivo metabolism were calculated. Plasma acetone concentrations (1.55-8.91 mM) were directly related and were generally greater than acetoacetate concentrations (1.16-6.08 mM). The rates of acetone production ranged from 68 to 581 mumol/min/1.73 m2, indicating the heterogeneous nature of the patients studied. The average acetone production rate was 265 mumol/min/1.73 m2 and accounted for about 52% of the estimated acetoacetate production rate. Urinary excretion of acetone remained constant and accounted for about 7% of the acetone production rate in all patients. There was a positive linear relationship between the percentage of the acetone production rate accounted for by excretion in breath and the plasma acetone concentration. At low plasma acetone concentrations, approximately 20%, and at high plasma acetone concentrations, approximately 80% of the production rate was accounted for by breath acetone. In contrast, there was a negative linear relationship between the percentage of acetone production rate undergoing in vivo metabolism and plasma acetone concentration. At low plasma acetone concentrations, approximately 75%, and at high concentrations, approximately 20% of acetone production rate was accounted for by in vivo metabolism. Radioactivity from 2-[14C]-acetone was variably present in plasma acetone, glucose, lipids and proteins. No radioactivity was found in plasma acetoacetate, Continue reading >>
Diabetic Ketoacidosis Clinical Presentation
History Insidious increased thirst (ie, polydipsia) and urination (ie, polyuria) are the most common early symptoms of diabetic ketoacidosis (DKA). Malaise, generalized weakness, and fatigability also can present as symptoms of DKA. Nausea and vomiting usually occur and may be associated with diffuse abdominal pain, decreased appetite, and anorexia. A history of rapid weight loss is a symptom in patients who are newly diagnosed with type 1 diabetes. Patients may present with a history of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons. Decreased perspiration is another possible symptom of DKA. Altered consciousness in the form of mild disorientation or confusion can occur. Although frank coma is uncommon, it may occur when the condition is neglected or if dehydration or acidosis is severe. Among the symptoms of DKA associated with possible intercurrent infection are fever, dysuria, coughing, malaise, chills, chest pain, shortness of breath, and arthralgia. Acute chest pain or palpitation may occur in association with myocardial infarction. Painless infarction is not uncommon in patients with diabetes and should always be suspected in elderly patients. A study by Crossen et al indicated that in children with type 1 diabetes, those who have had a recent emergency department visit and have undergone a long period without visiting an endocrinologist are more likely to develop DKA. The study included 5263 pediatric patients with type 1 diabetes. [15] Continue reading >>
Symptoms And Detection Of Ketoacidosis
Symptoms These symptoms are due to the ketone poisoning and should never be ignored. As soon as a person begins to vomit or has difficulty breathing, immediate treatment in an emergency room is required to prevent coma and possible death. Early Signs, Symptoms: Late Signs, Symptoms: very tired and sleepy weakness great thirst frequent urination dry skin and tongue leg cramps fruity odor to the breath* upset stomach* nausea* vomiting* shortness of breath sunken eyeballs very high blood sugars rapid pulse rapid breathing low blood pressure unresponsiveness, coma * these are more specific for ketoacidosis than hyperosmolar syndrome Everyone with diabetes needs to know how to recognize and treat ketoacidosis. Ketones travel from the blood into the urine and can be detected in the urine with ketone test strips available at any pharmacy. Ketone strips should always be kept on hand, but stored in a dry area and replaced as soon as they become outdated. Measurement of Ketones in the urine is very important for diabetics with infections or on insulin pump therapy due to the fact it gives more information than glucose tests alone. Check the urine for ketones whenever a blood sugar reading is 300 mg/dl or higher, if a fruity odor is detected in the breath, if abdominal pain is present, if nausea or vomiting is occurring, or if you are breathing rapidly and short of breath. If a moderate or large amount of ketones are detected on the test strip, ketoacidosis is present and immediate treatment is required. Symptoms for hyperglycemic hyperosmolar syndrome are linked to dehydration rather than acidosis, so a fruity odor to the breath and stomach upset are less likely. How To Detect Ketones During any illness, especially when it is severe and any time the stomach becomes upset, ketone Continue reading >>
Diabetic Ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication of diabetes caused by a lack of insulin in the body. It's important to seek medical advice quickly if you think that you or your child is experiencing the condition. Causes of diabetic ketoacidosis Diabetic ketoacidosis is a complication of diabetes that can occur if the body starts to run out of insulin. It's common in people with type 1 diabetes and can very occasionally affect those with type 2 diabetes. It sometimes develops in people who were previously unaware they had diabetes. Children and young adults are most at risk. Insulin enables the body to use blood sugar (glucose). If there is a lack of insulin, or if it can't be used properly, the body will break down fat instead. The breakdown of fat releases harmful, acidic substances called ketones.The lack of insulin in your body leads to high blood glucose levels (hyperglycaemia). The combination of high ketone and blood sugar levels can cause a number of symptoms that can be very serious if the levels aren't corrected quickly. Symptoms of diabetic ketoacidosis The initial symptoms of diabetic ketoacidosis can develop quite suddenly. They will continue to get worse if not treated. Early symptoms In the early stages, the main signs of diabetic ketoacidosis include: passing large amounts of urine severe thirst weight loss feeling sick tiredness You may also develop other symptoms of dehydration, such as a dry mouth. If you have your own device or kit to measure your blood sugar and/or ketone levels, you may notice that the levels of both of these are higher than normal. Advanced symptoms Left untreated, more advanced symptoms can develop, including: rapid heartbeat (tachycardia) rapid breathing, where you breathe in more oxygen than your body actua Continue reading >>
Acetone Breath And Diabetes
My husband is 58 and has type 2 diabetes. Two days ago his breath started to smell very strongly, and he was suddenly very tired and slightly nauseated. He recovered from this, and the smell went away. I've read about acetone breath in diabetics. Do you think that is what he had? What's the cause? — Alice, Connecticut Acetone breath in diabetics is caused by an excess production of acetone. Acetone, hydroxybutyrate, and acetoacetate are ketones, byproducts of fat metabolism. When the body does not have enough insulin (as is the case in people with diabetes), a hormone that is key in glucose metabolism, it instead uses fatty acids as an alternative source of energy, and ketones are the result of this process. Ketones are also produced during a fasting state or when consuming a ketogenic (high-fat, low-carbohydrate) diet. Ketones can cause nausea, vomiting, and fatigue. But I am concerned that your husband might be experiencing diabetic ketoacidosis, which is a serious and life-threatening condition. I suggest that you check your husband’s sugar level at the time you notice his acetone breath and contact his doctor for further advice. It is also quite likely that his acetone breath might be a result of missing meals. Learn more in the Everyday Health Type 2 Diabetes Center. Continue reading >>
Diabetic Ketoacidosis
Diabetic Ketoacidosis Definition Diabetic ketoacidosis is a dangerous complication of diabetes mellitus in which the chemical balance of the body becomes far too acidic. Description Diabetic ketoacidosis (DKA) always results from a severe insulin deficiency. Insulin is the hormone secreted by the body to lower the blood sugar levels when they become too high. Diabetes mellitus is the disease resulting from the inability of the body to produce or respond properly to insulin, required by the body to convert glucose to energy. In childhood diabetes, DKA complications represent the leading cause of death, mostly due to the accumulation of abnormally large amounts of fluid in the brain (cerebral edema). DKA combines three major features: hyperglycemia, meaning excessively high blood sugar kevels; hyperketonemia, meaning an overproduction of ketones by the body; and acidosis, meaning that the blood has become too acidic. Insulin deficiency is responsible for all three conditions: the body glucose goes largely unused since most cells are unable to transport glucose into the cell without the presence of insulin; this condition makes the body use stored fat as an alternative source instead of the unavailable glucose for energy, a process that produces acidic ketones, which build up because they require insulin to be broken down. The presence of excess ketones in the bloodstream in turn causes the blood to become more acidic than the body tissues, which creates a toxic condition. Causes and symptoms DKA is most commonly seen in individuals with type I diabetes, under 19 years of age and is usually caused by the interruption of their insulin treatment or by acute infection or trauma. A small number of people with type II diabetes also experience ketoacidosis, but this is rare give Continue reading >>
Sweet-smelling Breath To Help Diabetes Diagnosis In Children
The potential to quickly diagnose children with type 1 diabetes before the onset of serious illness could be achieved using a simple, non-invasive breath test, according to new research published today. In one of the most comprehensive breath-based studies of children with type 1 diabetes performed to date, a team of researchers from Oxford, UK have linked a sweet-smelling chemical marker in the breath with a build-up of potentially harmful chemicals in the blood that accumulate when insulin levels are low. It is hoped these results—linking an increased level of breath acetone with increased levels of ketones in the blood—could inspire the development of a diagnostic device to identify children with new diabetes before the onset of diabetic ketoacidosis (DKA). The results of the study have been published today, 26 November, in IOP Publishing’s Journal of Breath Research. DKA occurs when a severe lack of insulin means the body cannot use glucose for energy and starts to break down fat instead. Organic compounds called ketones are the by-product of the breakdown of fat and, if left unchecked, can build up and cause the body to become acidic. About one in four children diagnosed with type 1 diabetes don’t know they have it until they develop DKA, which can cause severe illness. Acetone, which is the simplest ketone, is one of the by-products produced in the development of DKA and is usually disposed of through the breath. Indeed, for over 200 years acetone has been known to produce a sweet smell on the breath of diabetes sufferers. In their study, the researchers, from the University of Oxford, Oxford Medical Diagnostics and Oxford Children’s Hospital, collected the breath samples from 113 children and adolescents between the ages 7 and 18. Isoprene and acetone w Continue reading >>
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 >>
Breath Acetone Is A Reliable Indicator Of Ketosis In Adults Consuming Ketogenic Meals1,2,3
Abstract Background: Ketogenic diets are used therapeutically to treat intractable seizures. Clinically, it appears that the maintenance of ketosis is crucial to the efficacy of the diet in ameliorating seizures. To understand how ketosis and seizure protection are related, a reliable, noninvasive measure of ketosis that can be performed frequently with minimal discomfort is needed. Objective: The objective was to determine which index, breath acetone or urinary acetoacetate, is more strongly related to the plasma ketones acetoacetate and β-hydroxybutyrate. Design: After fasting overnight for 12 h, 12 healthy adults consumed 4 ketogenic meals over 12 h. Blood, breath, and urine samples were collected hourly. Blood was analyzed for plasma acetoacetate and β-hydroxybutyrate, breath for acetone, and urine for acetoacetate. Results: By the end of the 12-h dietary treatment, plasma acetoacetate, plasma β-hydroxybutyrate, and breath acetone had increased 3.5-fold, whereas urinary acetoacetate increased 13-fold when measured enzymatically and 25-fold when measured with urinary ketone dipsticks. Plasma acetoacetate was best predicted by breath acetone (R2 = 0.70, P < 0.0001). Plasma β-hydroxybutyrate was equally predicted by breath acetone and urinary acetoacetate (R2 = 0.54, P = 0.0040). Conclusions: Breath acetone is as good a predictor of ketosis as is urinary acetoacetate. Breath acetone analysis is noninvasive and can be performed frequently with minimal discomfort to patients. As an indicator of ketosis in epilepsy patients consuming a ketogenic diet, breath acetone may be useful for understanding the mechanism of the diet, elucidating the importance of ketosis in seizure protection, and ultimately, enhancing the efficacy of the diet by improving patient monitoring. I Continue reading >>
Akers Biosciences Completes Clinical Trial For Rapid Diabetic Ketoacidosis Breath Test
THOROFARE, NJ -- (Marketwired) -- 11/28/16 -- Akers Biosciences, Inc. (NASDAQ: AKER) (AIM: AKR.L), ("Akers Bio" or the "Company"), a developer of rapid health information technologies, has completed a clinical trial for BreathScan® DKA, the first single-use, non-invasive breath test to rapidly screen for diabetic ketoacidosis, a potentially life-threatening complication of diabetes caused by a lack of insulin in the body. The clinical trial was performed at Thomas Jefferson University Hospital in Philadelphia, PA, on patients admitted to the emergency department with suspected ketoacidosis. The results were highly successful, with sensitivity (a true positive result) of 91% and specificity (a true negative result) of 93%. The overall agreement between the BreathScan® DKA test and the gold standard hospital blood test was 92%. The BreathScan® DKA test utilizes Akers Bio's proprietary MPC Biosensor Technology, which permits the rapid identification of medical or metabolic conditions through biomarkers in exhaled breath condensate. BreathScan® DKA is a first-in-class device that detects the presence of ketones in a person's breath condensate. Ketones are present in the blood before they can be detected in urine; and breath and blood ketone levels are closely correlated. Ketones are acids that have the potential to build up in the body causing a condition referred to as ketosis. An extreme form of this complication is ketoacidosis. At-risk populations for ketoacidosis include those with diabetes, and persons who subscribe to restrictive ketogenic diets for epilepsy management or to obtain aggressive weight loss results. Current tests for this condition are primarily performed in a hospital or reference laboratory, and can take hours to produce a result. These tests must Continue reading >>
Respiratory System And Diabetes
Tweet The respiratory system is the system of organs that allow the body to take in oxygen and expel carbon dioxide, this process is known as gaseous exchange. We generally breathe between 12 and 20 times a minute. There are a number of complications of diabetes that can negatively affect our breathing. Parts of the respiratory system The following parts of the body make up the respiratory system: Mouth and nose Trachea (windpipe) Lungs Diaphragm How the respiratory system works Breathing is usually initiated by contraction of the diaphragm, a muscle which separates the chest cavity from the abdomen. As the diaphragm contracts, more space is made available in the chest cavity and this has the effect of creating suction as the lungs expand to fill the space. The lungs draw in air through the nose and/or mouth which then travels down the trachea (windpipe) before reaching the lungs. Within the lungs are tiny air sacs called alveoli which allow oxygen from the air we breathe to be absorbed into the many tiny blood vessels contained with the alveoli. As this happens, the alveoli take in carbon dioxide from the blood vessels and this completes gaseous exchange. With gaseous exchange complete, the diaphragm relaxes and the carbon dioxide rich air in the lungs is expelled via the trachea out of the mouth and/or nose. The lungs As noted above, it is within the lungs that the gaseous exchange of oxygen and carbon dioxide takes place. The lungs are filled with a branched structure of airways called bronchi and smaller airways called bronchioles. Located at the end of the bronchioles are the alveoli in which the exchange of gases takes place. The average capacity of human lungs is between 4 and 6 litres of air. The capacity of lungs may be reduced if the lungs become diseased or d Continue reading >>
Why Does My Breath Smell Like Acetone?
People often associate strong smelling breath with the food someone has eaten or poor dental hygiene. But it may reveal much more than that. If a person's breath smells like acetone or nail polish remover, it could indicate health conditions, including diabetes. The way a person's breath smells can be an indicator of their overall health. This article explores why a person's breath might smell like acetone and what this might mean about their health. Contents of this article: How diabetes can affect breath Diabetes can affect the way a person's breath smells and can cause bad breath, or halitosis. In a 2009 study, researchers found that analyzing a person's breath helped to identify prediabetes when diabetes is in its early stages. There are two conditions associated with diabetes that can cause bad breath: gum disease and a high ketone level. The proper name for gum diseases in periodontal disease, and its forms include: Diabetes can be associated with an increased risk of gum disease, which may cause a person's breath to smell bad. However, gum disease does not cause a person's breath to smell like acetone. If a person has diabetes and their breath smells like acetone, this is usually caused by high levels of ketones in the blood. Diabetes and acetone breath When diabetes is not managed well, the body does not make enough insulin to break down glucose in the blood. This means that the body's cells do not receive enough glucose to use as energy. When the body cannot get its energy from sugar, it switches to burning fat for fuel instead. The process of breaking down fat to use as energy releases by-products called ketones. Ketone bodies include acetone. Acetone is the same substance that is used in nail varnish remover and is distinguished by its fruity smell. When a pe Continue reading >>
Diabetic Ketoacidosis: Evaluation And Treatment
Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in children. Physicians should recognize the signs of diabetic ketoacidosis for prompt diagnosis, and identify early symptoms to prevent it. Patient education should include information on how to adjust insulin during times of illness and how to monitor glucose and ketone levels, as well as i Continue reading >>
Hypoglycemia, Diabetes, And Blood Alcohol Tests
It has been found that diabetes and hypoglycemia can be related to accidents and errors on today's road. Even more common, are unjustified DWI and DUI arrests concerning patterns normally associated with a drunk driver. In a healthy individual, blood glucose (blood sugar) will be from 70 to 120 mg/dl. When blood glucose rises above 120 mg/dl and there is no insulin present, diabetes occurs. Insulin is a hormone controlled by your pancreas that is required to digest and keep a blood sugar balance. If blood glucose decreases to 60 mg/dl or lower, hypoglycemia will occur. Four different forms of diabetes exist, each with its own treatment. The first, Type 1, is typically diagnosed in children with juvenile onset diabetes. Although less common, it is possible for adults to be diagnosed (refer to www.diabetes.org). With Type 1, insulin must be injected into the body because the pancreas fails to produce any insulin at all; leaving it to be the most dangerous of the four types. With Type 2 diabetes, the body can create insulin, but not enough. The body is also resistant to the insulin and does not make use of it in the right way. For Type 2, the treatments include a new diet, exercise, and, on occasion, insulin tablets. Gestational Diabetes and Pre-diabetes are the last of the four types. Gestational Diabetes is most commonly temporary, and is diagnosed during pregnancy. Pre-diabetes occurs when the blood sugar is higher than usual, but still not at the level of Type 2 diabetes. The reason this is all very pertinent is because the symptoms caused by diabetes or hypoglycemia can all too easily be confused with an intoxicated individual. And, while these symptoms are typically seen in a diabetic or hypoglycemic, they can also be seen in a non-diabetic individual. If a person is Continue reading >>
- Alcohol and diabetes: How does it affect blood sugar levels?
- Tiny sensor placed under the skin to replace finger prick tests for diabetes: Smartphone app will alert patients if their blood sugar level drops or is too high
- Drinking Wine For Diabetes Prevention: Moderate Alcohol Consumption Manages Blood Sugar
Breath Ketone Testing: A New Biomarker For Diagnosis And Therapeutic Monitoring Of Diabetic Ketosis
Go to: 1. Introduction Diabetic ketoacidosis (DKA) is a life-threatening condition that occurs predominantly in patients with newly diagnosed type 1 diabetes mellitus and is a consequence of a lack of insulin production by pancreatic islet cells, but it may also occur in patients with type 2 diabetes with poorly controlled blood glucose concentration or other diseases [1]. Diabetic ketosis and ketoacidosis are mainly caused by a lack of insulin or an inappropriate rise in blood glucagon concentration that leads to sugar, protein, fat, water, electrolyte, and acid-base imbalance. Identifying a testing method with high sensitivity and specificity would facilitate the early diagnosis and treatment of diabetic ketosis. Ketone bodies are produced when the liver metabolizes fatty acids, including acetone, β-hydroxybutyrate, and acetoacetic acid: β-hydroxybutyrate can be converted into acetoacetic acid and accounts for 78% of all ketones in the body, followed by acetoacetic acid (20%) and acetone (2%). Clinically, when making the diagnosis of DKA, blood ketone concentration is generally inferred from the urinary ketone concentration. Commonly used detection methods for urinary ketones are more sensitive to acetoacetic acid than acetone but less sensitive to β-hydroxybutyrate, which appears earliest in DKA—explaining why patients with DKA may not have detectable concentrations of ketones in their urine. Urinary ketone excretion may also be impaired in patients with renal dysfunction. It can be argued that detecting urinary ketones is not a suitable means of diagnosing DKA. A blood test that measures the concentration of serum β-hydroxybutyrate is available, but there has been a great deal of interest in developing means of measuring the concentration of ketones in the bre Continue reading >>
