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Ketoacidosis Breath

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

Drunk Versus Diabetes: How Can You Tell?

Drunk Versus Diabetes: How Can You Tell?

Dispatch calls your EMS unit to the side of a roadway, where police officers have detained a driver on suspicion of driving under the influence of alcohol intoxication. You find the female driver handcuffed in the back seat of a police cruiser. She is screaming profanities and hitting her head against the side window. An officer tells you that she was weaving in and out of traffic at highway speed, and it took several minutes to pull her over. She was noncooperative and it took several officers to subdue her. She sustained a laceration to her head, which the officers want you to evaluate. The woman continues to swear at you as you open the car door. You note that she is diaphoretic and breathing heavily. You can smell what appears to be the sour, boozy smell of alcohol, even though you are not close to her. You can see that the small laceration near the hairline on her right forehead has already stopped bleeding. Her speech is slurred and she appears to be in no mood to be evaluated. The police officers are ready to take her down to the station to be processed for driving under the influence. Sound familiar? It should — this is a scene that is played out often in EMS systems. While it may seem initially that these incidents are not medical in nature, they really deserve close attention by the EMS personnel. In this article we will focus on the challenges of evaluating a patient who is intoxicated versus a patient who is experiencing an acute diabetic emergency. There have been numerous instances where EMS providers have exposed themselves to serious liability secondary to medical negligence. Let's take a closer look. Diabetes Diabetes is a serious disease that affects nearly 29 million people in the United States [1]. Advances in diabetic care have resulted in an impr Continue reading >>

Symptoms And Detection Of Ketoacidosis

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

As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>

Ask The Diabetes Team

Ask The Diabetes Team

Question: From Gerrards Cross, England (for one year) then Dresher, Pennsylvania, USA: My six year old adopted son has had acetone breath consistently for several weeks. I've tested his urine with the strips for glucose and ketones twice, and they are both negative. He has had this previously only when he was slightly dehydrated from bouts of nausea and vomiting. He is otherwise perfectly healthy and active and has no symptoms of diabetes. We have a dog with diabetes which is why I am familiar with the signs and the breath odor and have the urine strips. Are there other causes of acetone breath in an otherwise normal six year old? In view of the negative strips should I still have his blood glucose tested? Answer: Not everyone can smell acetone, but if you can, the most sensitive vehicle is the breath which may explain why urine testing has been negative. Ketosis in children can occur when the body is unable to get sufficient basal energy needs from the metabolism of carbohydrate and resorts to the breakdown of fat stores with the production of ketones. This can occur because of diabetes, but, as you have noticed, this is most likely to occur when appetite is diminished by intercurrent illness. The same can happen if energy consumption is increased and a child is too busy to eat sufficiently. I think it very unlikely that what you describe has anything to do with diabetes, but if you have a diabetic dog and the means of measuring blood sugars you might test your son after a period of energetic activity to see if it is low because the phenomenon I have described is called ketotic hypoglycemia. Additional comments from Dr. Andrea Scaramuzza: When you have excluded diabetes, as in the case of your son because both urine and blood glucose are in normal range, you can take i Continue reading >>

Sweet-smelling Breath To Help Diabetes Diagnosis In Children

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 >>

Breath Acetone Is A Reliable Indicator Of Ketosis In Adults Consuming Ketogenic Meals1,2,3

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 >>

Acetone Metabolism During Diabetic Ketoacidosis

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 > acetoacetate concentrations (1.16–6.08 mM). The rates of acetone production ranged from 68 to 581 μmol/min/1.73 m2, indicating the heterogeneous nature of the patients studied. The average acetone production rate was 265 μmol/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, ∼ 20%, and at high plasma acetone concentrations, ∼ 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, ∼ 75%, and at high concentrations, ∼ 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, beta-hydroxy butyrate or free fatty acids or o Continue reading >>

Hypoglycemia, Diabetes, And Blood Alcohol Tests

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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>

Breath Ketone Testing: A New Biomarker For Diagnosis And Therapeutic Monitoring Of Diabetic Ketosis

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 >>

Acetone Metabolism During Diabetic Ketoacidosis.

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 >>

Ketosis Breath: Causes & Solutions For Bad Breath

Ketosis Breath: Causes & Solutions For Bad Breath

Ultra-low carb diets have grown in popularity over recent years. These so-called “keto diets” aim to facilitate rapid weight loss, through the consumption of minimal carbohydrates. Keto diets have become understandably popular on account of their rapid results, together with the practical benefits of consuming healthy volumes of the right foods, making hunger less of a problem than on more typical calorie-controlled diets. However keto diets are not without their issues, and one of the most common complaints comes in the form of “ketosis breath”. Quite simply many individuals making use of very low carb diets suffer from pungent and unpleasant breath. The question is what can be done to counteract such a problem? The Cause of Ketosis Breath In order to learn how to get rid of keto breath, we first need to understand why breath can smell under such a regime. As it turns out there are two potential reasons(1), both of which can operate independently, or in conjunction. Ketone Release The most typical source of energy used by the body is glucose. This is typically derived from carbohydrates, where the digestive system breaks down complex sugars into simple glucose molecules. On very low carb diets, however, the body is unable to utilize such a fuel. Instead, the liver utilizes the fat present in the body as an energy source, producing “ketones” in the process(2). This is known as “ketosis” – and is the process from where keto diets get their unusual name. These ketone bodies come in three common forms; acetoacetate, beta-hydroxybutyrate and acetone(3). In large quantities they are removed from the body in the urine or through exhalation. Ketones can have quite a characteristic smell; they often make the dieter’s breath smell quite sweet and fruity, quit Continue reading >>

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