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Ketoacidosis Breath

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 >>

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 And Patho

Diabetic Ketoacidosis And Patho

pathophysiology ketogenesis due to insulin deficiency leads to increased serum levels of ketones anad ketonuria acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic acids that cause metabolic acidosis respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid respirations (Kussmaul breathing) acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis patients elevated anion gap Methanol intoxication Uremic acidosis Diabetic ketoacidosis Paraldehyde ingestions Intoxicants (salicyclate, ethylene glycol, nipride, epinephrine, norepinephrine) Lactic acidosis (drug induced; didanosine, iron, isoniazid, metformin, zidovudine) Ethanol ketoacidosis Severe renal failure starvation Blood glucose regulation (6) 1. When blood glucose levels rise above a set point, 2. the pancreas secretes insulin into the blood. 3. Insulin stimulates liver and muscle cells to make glycogen, dropping blood glucose levels. 4. When glucose levels drop below a set point, 5. the pancreas secretes glucagon into the blood. 6. Glucagon promotes the breakdown of glycogen and the release of glucose into the blood. (The pancreas signals distant cells to regulate levels in the blood = endocrine function.) Insulin and Glucagon (Regulation) (10) 1. High blood glucose 2. Beta cells 3. Insulin 4. Glucose enters cell 5. Blood glucose lowered 6. Low blood glucose 7. Alpha cells 8. Glucagon 9. Liver releases glucose from glycogen 10. Blood glucose raised What is the manifestations (symptoms) of Type 1? (10) 1. Extreme thirst 2. Frequent urination 3. Drowsiness, lethargy 4. Sugar in urine 5. Sudden vision change 6. Increased appetite 7. Sudden weight loss 8. Fruity, sweet, or wine like odor on breath 9. Heavy, laboured breathing 10. Stupor, unconscious Continue reading >>

Diabetic Ketoacidosis

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

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 >>

Diabetic Ketoacidosis In Children

Diabetic Ketoacidosis In Children

WHAT YOU NEED TO KNOW: What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. Your child's blood sugar levels become high because his body does not have enough insulin. Insulin helps move sugar out of the blood so it can be used for energy. The lack of insulin forces his body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in the blood. Ketones are dangerous at high levels. What increases my child's risk for DKA? Not enough insulin Poorly controlled diabetes Infection or other illness Heart attack, stroke, trauma, or surgery Emotional stress Being female What are the signs and symptoms of DKA? Your child may feel very thirsty, and urinate more than usual. He may have a fever. He may also have any of the following: Dry mouth, eyes, and skin Fast, deep breathing Faster heartbeat than normal for him Abdominal pain, nausea, and vomiting Fruity, sweet breath Mood changes and irritability Feeling very weak, tired, and confused Weight loss How is DKA treated? DKA can be life-threatening. Your child must get immediate medical attention. The goal of treatment is to replace lost body fluids, and to bring blood sugar levels back to normal. How can I help prevent DKA? The best way to prevent DKA is to help your child control his diabetes. Ask your child's healthcare provider for more information on how to manage your child's diabetes. The following may help decrease your child's risk for DKA: Monitor your child's blood sugar levels closely if he has an infection, is stressed, sick, or experiences trauma. Check his blood sugar levels often. You may need to check at least 3 times each day. If your child's blood sugar level is too high, 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 >>

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 >>

Why Does My Breath Smell Like Acetone?

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 >>

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 >>

Akers Biosciences Completes Clinical Trial For Rapid Diabetic Ketoacidosis Breath Test

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 >>

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 >>

Sweet-smelling Breath Holds Promise As Tool For Diagnosing Diabetes

Sweet-smelling Breath Holds Promise As Tool For Diagnosing Diabetes

A simple breath test may be able to quickly and noninvasively diagnose children who have Type 1 diabetes, according to new research from the United Kingdom. Every year, more than 15,000 children (and 15,000 adults) in the United States are diagnosed with Type 1. Roughly one in four children who have Type 1 diabetes are not diagnosed until they develop diabetic ketoacidosis, a severe and potentially fatal hyperglycemic (high blood glucose) condition that develops when the body lacks the insulin to convert glucose into energy and instead begins to break down fat. By-products of this process known as ketones can build up and cause the body to become acidic. Previous studies have indicated that gases in the breath are related to blood glucose and blood ketone levels in adults with Type 1 and Type 2 diabetes. To determine whether this is also true in children, researchers in Oxford collected breath samples from 113 children and adolescents with Type 1 diabetes between the ages of 7 and 18. Levels of the breath gases isoprene and acetone were measured and compared to blood glucose and blood ketone levels taken from the capillaries during the same visit. Although there was no link between isoprene or acetone levels in the breath and glucose levels in the blood, the researchers did find a significant association between increased levels of breath acetone and increased levels of blood ketones. “Our results have shown that it is realistically possible to use measurements of breath acetone to estimate blood ketones,” says study coauthor Gus Hancock, PhD. “We are working on the development of a small hand held device that would allow the possibility of breath measurements for ketone levels and help to identify children with new diabetes before DKA supervenes. Currently testin 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 >>

Diabetic Ketoacidosis: Evaluation And Treatment

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 >>

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