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Ketoacidosis Breath

> Hyperglycemia And Diabetic Ketoacidosis

> Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in 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 >>

Acetone Breath And Diabetes

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

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 >>

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 >>

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 >>

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 >>

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 >>

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 >>

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

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 >>

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

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 >>

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 >>

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 >>

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