Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia. Treatment is IV saline solution and dextrose infusion. Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism. Alcohol diminishes hepatic gluconeogenesis and leads to decreased insulin secretion, increased lipolysis, impaired fatty acid oxidation, and subsequent ketogenesis, causing an elevated anion gap metabolic acidosis. Counter-regulatory hormones are increased and may further inhibit insulin secretion. Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. Diagnosis requires a high index of suspicion; similar symptoms in an alcoholic patient may result from acute pancreatitis, methanol or ethylene glycol poisoning, or diabetic ketoacidosis (DKA). In patients suspected of having alcoholic ketoacidosis, serum electrolytes (including magnesium), BUN and creatinine, glucose, ketones, amylase, lipase, and plasma osmolality should be measured. Urine should be tested for ketones. Patients who appear significantly ill and those with positive ketones should have arterial blood gas and serum lactate measurement. The absence of hyperglycemia makes DKA improbable. Those with mild hyperglycemia may have underlying diabetes mellitus, which may be recognized by elevated levels of glycosylated Hb (HbA1c). Typical laboratory findings include a high anion gap metabolic acidosis, ketonemia, and low levels of potassium, magnesium, and phosphorus. Detection of acidosis may be com Continue reading >>
acidosis [as″ĭ-do´sis] 1. the accumulation of acid and hydrogen ions or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, resulting in a decrease in pH. 2. a pathologic condition resulting from this process, characterized by increase in hydrogen ion concentration (decrease in pH). The optimal acid-base balance is maintained by chemical buffers, biologic activities of the cells, and effective functioning of the lungs and kidneys. The opposite of acidosis is alkalosis. adj., adj acidot´ic. Acidosis usually occurs secondary to some underlying disease process; the two major types, distinguished according to cause, are metabolic acidosis and respiratory acidosis (see accompanying table). In mild cases the symptoms may be overlooked; in severe cases symptoms are more obvious and may include muscle twitching, involuntary movement, cardiac arrhythmias, disorientation, and coma. In general, treatment consists of intravenous or oral administration of sodium bicarbonate or sodium lactate solutions and correction of the underlying cause of the imbalance. Many cases of severe acidosis can be prevented by careful monitoring of patients whose primary illness predisposes them to respiratory problems or metabolic derangements that can cause increased levels of acidity or decreased bicarbonate levels. Such care includes effective teaching of self-care to the diabetic so that the disease remains under control. Patients receiving intravenous therapy, especially those having a fluid deficit, and those with biliary or intestinal intubation should be watched closely for early signs of acidosis. Others predisposed to acidosis are patients with shock, hyperthyroidism, advanced circulatory failure, renal failure, respiratory disorders, or liver disease. Continue reading >>
Case Of Nondiabetic Ketoacidosis In Third Term Twin Pregnancy | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic
We provided appropriate management with fluid infusion after cesarean delivery. The patient and her two daughters survived, and no disabilities were foreseen. Alcohol, methanol, and lactic acid levels were normal. No signs of renal disease or diabetes were present. Pathological examination revealed no abnormalities of the placentae. Toxicological tests revealed a salicylate level of less than 5 mg/liter, an acetaminophen level of less than 1 mg/liter, and an acetone level of 300 mg/liter (reference, 520 mg/liter). We present a case of third term twin pregnancy with high anion gap metabolic acidosis due to (mild) starvation. Starvation, obesity, third term twin pregnancy, and perhaps a gastroenteritis were the ultimate provoking factors. In the light of the erroneous suspicion of sepsis and initial fluid therapy lacking glucose, one wonders whether, under a different fluid regime, cesarean section could have been avoided. Severe ketoacidosis in the pregnant woman is associated with impaired neurodevelopment. It therefore demands early recognition and immediate intervention. A 26-yr-old patient was admitted to our hospital complaining of rapid progressive dyspnea and abdominal discomfort. She was pregnant with dichorial, diamniotic twins for 35 wk and 4 d. Medical history showed that she was heterozygous for hemochromatosis. Two years before, she had given birth to a healthy girl of 3925 g by cesarean section, and 1 yr before, she had had a spontaneous abortion. Her preadmission outpatient surveillance revealed slightly elevated blood pressure varying from 132158 mm Hg systolic and 7995 mm Hg diastolic. Glucose and glycosylated hemoglobin were tested at 24 wk and were normal at 4.6 mmol/liter and 5.4% (36 mmol/mol), respectively. Urine analysis at the outpatient obstetri Continue reading >>
Ketonuria - Symptom, Causes And Treatment
Ketonuria is a medical condition where high levels of ketone bodies are present in the urine. Ketone bodies occur when cells are broken down for energy. Usually carbohydrates are the main source of energy for the body and small amounts of ketones are produced as a metabolic by-product. These ketone bodies are broken down in the liver and usually high concentrations do not show up in urine. However, during fasting or certain diseases such as type I Diabetes there is glucose shortage in the blood and body resorts to breaking down fats for energy. A high amount of ketones is generated as a metabolic byproduct when fat is the main source of energy. These ketones can buildup in the body and cause further damage. Ketonuria can be a highly dangerous condition if the ketones levels are high. People who have insufficient insulin are more likely to produce ketones. Therefore, people with type 1 diabetes are at higher risk for ketonuria. When the body is producing low amountof insulin, then the body will start preparing for alternate measure for energy.Due to the lack of sufficient insulin to get energy, the body will start breaking down body tissue into ketones, which can be used as fuel in the lack of insulin. The causes and treatmentof ketonuria differ from person to person and the course of treatment depends on the original cause. Here are some of the most common causes of ketonuria. Causes of ketonuria Ketonuria is primarily caused by the high levels of ketones in the urines of a person. So everything that can lead to release of high amount of ketones into the blood or urines can cause ketonuria. The most common such causes of ketonuria causes are: Metabolic abnormalities Any condition which causes a reduction in glucose availability in the bloodstream such as diabetes or ren Continue reading >>
What Is Starvation Ketosis?
Starvation ketosis is a metabolic state in humans and many animals in which the body breaks down fat and produces acids known as ketones, then uses these as a primary energy source. The “starvation” part of the name owes to the fact that, in most cases, people only use ketones for energy when they aren’t getting adequate glucose from food. The body typically converts carbohydrates to glucose as a main source of energy, but once the liver has used all of its stored glucose it begins to metabolize fatty acids, forming ketone bodies. Malnutrition and fasting are two of the most common causes, but it can also be the result of conditions like diabetes, alcoholism, and a low carbohydrate diet. People sometimes intentionally trigger this state as a means of burning fat to lose weight, but whether this practice is safe or even advisable is widely disputed in the medical community. Ketones are capable of supplying energy to the body, but an abnormally high level can cause a number of problems, including organ damage, coma, and even death. Understanding Ketones The liver typically makes ketones in response to some sort of energy crisis in the body. People generally get the majority of their energy by synthesizing glucose, which is a sugar molecule found in carbohydrates like bread and grain products. When people aren’t getting enough glucose, the liver begins creating ketones that the body uses in combination with any fat stores it has on hand. Ketones in many ways prevent the body from robbing muscles of their core proteins. Starvation ketosis happens when these become the body’s primary source of energy. The condition can usually be identified by looking for excesses. The body gets rid of unneeded supplies by spilling them out through exhalations, urine, and sweat. Wh Continue reading >>
The Paleo Guide To Ketosis
Ketosis is a word that gets tossed around a lot within the Paleo community – to some, it’s a magical weight-loss formula, to others, it’s a way of life, and to others it’s just asking for adrenal fatigue. But understanding what ketosis really is (not just what it does), and the physical causes and consequences of a fat-fueled metabolism can help you make an informed decision about the best diet for your particular lifestyle, ketogenic or not. Ketosis is essentially a metabolic state in which the body primarily relies on fat for energy. Biologically, the human body is a very adaptable machine that can run on a variety of different fuels, but on a carb-heavy Western diet, the primary source of energy is glucose. If glucose is available, the body will use it first, since it’s the quickest to metabolize. So on the standard American diet, your metabolism will be primarily geared towards burning carbohydrates (glucose) for fuel. In ketosis, it’s just the opposite: the body primarily relies on ketones, rather than glucose. To understand how this works, it’s important to understand that some organs in the body (especially the brain) require a base amount of glucose to keep functioning. If your brain doesn’t get any glucose, you’ll die. But this doesn’t necessarily mean that you need glucose in the diet – your body is perfectly capable of meeting its glucose needs during an extended fast, a period of famine, or a long stretch of very minimal carbohydrate intake. There are two different ways to make this happen. First, you could break down the protein in your muscles and use that as fuel for your brain and liver. This isn’t ideal from an evolutionary standpoint though – when you’re experiencing a period of food shortage, you need to be strong and fast, Continue reading >>
What Are The Possible Complications Of Starvation Ketosis?
The most serious possible complication of starvation ketosis is a state called metabolic acidosis, where the pH level of the blood drops to a dangerous level. This can lead to a cascading series of problems, potentially resulting in death if issues are not addressed. Patients can also experience complications associated with poor nutrition and nutrient deprivation which may exacerbate the situation. Treating starvation ketosis requires carefully supporting the patient nutritionally and rebuilding the diet for recovery. As people stop eating, for whatever reason, their bodies turn to stored sources of energy for fuel. In particular, the liver starts burning fat, creating ketones as a byproduct. In the early phases of ketosis, patients may notice a fruity smell on their breath, indicating the rising levels of ketones, which the body tries to eliminate through the lungs. As the ketosis progresses, the blood can start to become acidic. Organ damage can occur, because the body is used to operating with a stable acid-base balance. In addition, the brain may start to swell, which can lead to coma. If the patient does not receive treatment, these complications can lead to death as the organs shut down and the patient loses brain function. Patients can also experience long-term health problems after surviving starvation ketosis, like impaired liver and kidney function or brain damage, if they didn’t receive treatment early enough. As patients starve, they can notice side effects like fatigue, extreme cold, blurred thinking, and impaired coordination. These are all complications of ketosis, related to the body’s decision to burn fat stores for energy. As the condition affects the brain, cognitive function can decline and the patient may experience difficulty with even basic t 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 >>
Ketosis, metabolic disorder marked by high levels of ketones in the tissues and body fluids, including blood and urine. With starvation or fasting, there is less sugar than normal in the blood and less glycogen (the storage form of sugar) in the cells of the body, especially the liver cells; fat accumulates in the liver, as do amino acids, from which the liver can produce more glycogen. Ketosis may be present in diabetes mellitus. In diabetic ketoacidosis, characterized by excessive levels of ketones in the blood that lead to a decrease in blood pH, very high blood sugar and severe intravascular and cellular dehydration create a life-threatening disorder that requires immediate treatment. When cattle are affected by ketosis, they lose weight and produce less milk; dietary adjustment to meet the special requirements of individual cattle helps avoid the condition. Continue reading >>
What Is Ketosis, And How Long Does It Take To Get Into Ketosis?
Ketosis is a natural state of the body in which it is fueled almost solely by fat. This happens when a person fasts or adheres to a very low carbohydrate diet. The exciting thing about ketosis and ketogenic diets is that you can lose a lot of weight while eating a normal quantity of food. You don’t have to suffer through skimpy portions. There are other benefits of keeping a ketogenic diet as well. These will be explained in the following article. An Explanation of Ketosis The root “keto” in the word ketosis comes from the type of fuel that the body produces when blood sugar is in low supply. The small molecules that are used as fuel are called “ketones.” If you consume very few carbohydrates and only a moderate amount of protein, then the body begins to produce ketones. Ketones are made by the liver from fat. Both the body and the brain can use them as fuel. The brain cannot directly function from fat. It must convert the fat into ketones. Legionella Testing Lab - High Quality Lab Results CDC ELITE & NYSDOH ELAP Certified - Fast Results North America Lab Locations legionellatesting.com When you go on a ketogenic diet, your body almost solely runs on fat. Your insulin levels become rather low as well. Since you are burning so much fat, this is a great way to lose weight. Studies show that ketogenic diets result in greater weight loss. The fastest way to get into ketosis is by fasting. However, you cannot fast for very long, so you need to start a low carb diet. The Brain and Ketones Many people think that the brain needs carbohydrates to function. This is not really true. The brain can work well simply by burning ketones. The reality is that many people feel like they have even more energy and focus when they are fueled by ketones. Benefits of Ketosis There ar Continue reading >>
Fasting Ketosis And Alcoholic Ketoacidosis
INTRODUCTION Ketoacidosis is the term used for metabolic acidoses associated with an accumulation of ketone bodies. The most common cause of ketoacidosis is diabetic ketoacidosis. Two other causes are fasting ketosis and alcoholic ketoacidosis. Fasting ketosis and alcoholic ketoacidosis will be reviewed here. Issues related to diabetic ketoacidosis are discussed in detail elsewhere. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment".) PHYSIOLOGY OF KETONE BODIES There are three major ketone bodies, with the interrelationships shown in the figure (figure 1): Acetoacetic acid is the only true ketoacid. The more dominant acid in patients with ketoacidosis is beta-hydroxybutyric acid, which results from the reduction of acetoacetic acid by NADH. Beta-hydroxybutyric acid is a hydroxyacid, not a true ketoacid. Continue reading >>
Ketosis Vs Ketoacidosis
Ever since the discovery of the Atkins diet, low carb diets have been hugely popular amongst people of all ages, genders, shapes, and sizes. It wasn’t until the media decided to focus on them so much however, largely because many Hollywood celebrities were using them to drop body fat, increase lean muscle mass and build physiques to be proud of, that the general public began experimenting with them and trying them for themselves. In order for any low carb to be deemed as effective however, the body has to fall into a metabolic state known as ketosis. Ketosis is considered largely beneficial, but is also often confused for ketoacidiosis, which couldn’t be more different. Here we’ll be taking a look at what ketosis and ketoacidosis is, and exactly how and why they’re so different from one another. So, without any further hesitation, let’s get started. What is ketosis? – Ketosis naturally occurs when blood circulating throughout the body contains naturally high concentrations of ketones, or ketoacids. Ketosis occurs because of a change in the body’s natural pathways of energy creation. Normally, the body’s preferred energy source is glucose, which is a form of sugar. Glucose can naturally be absorbed via the diet, and it can also be synthesised from other forms of sugar. When we take away glucose, sugars, and food sources that the body can use to convert into glucose however, the body then falls into starvation mode because it literally has no energy. The body will begin to panic as it will fear it is starving and it will therefore begin looking elsewhere for other sources of energy. It will begin using stored body fat for energy once it falls into a state of ketosis. Ketosis is able to occur as a result of our livers actually burning body fat and using it Continue reading >>
Insulin Drip In Euglycemic Ketoacidosis - A Tough Nut To Crack!
Abstract: This abstract also was presented at the 15th annual Rachmiel Levine Diabetes and Obesity Symposium on March 2, 2015, Levine Poster Number: 39. Background: Metabolic ketoacidosis has been frequently associated with three major etiologies which include diabetes, alcohol and starvation. Treatment is tailored towards the cause and usually involves crystalloid infusion in alcohol and starvation ketosis and implementation of insulin drip in diabetic ketoacidosis. On the contrary our patient presents with a challenging scenario which warrants further insight to the treatment strategies of metabolic ketoacidosis. Clinical Case: A 59-year-old male with past medical history of diabetes and alcoholism presented to the ER with coffee ground emesis for 3 days. One week prior to admission the patient fell off the stairs and injured his left shoulder. Thereafter he consumed alcohol for pain relief and had not eaten anything. He admits to not taking his insulin for last 2 days. Upon admission vitals were stable. His labs were significant for Hb- 10.4 (n 11.6-16.8) g/dL, INR- 1.0 (n 0.9-1.1), blood glucose- 106 (n 70-115) mg/dL, BUN- 15 (n 6-20) mg/dL, Cr- 0.6 (n 0.7-1.2) mg/dL, Na- 133 (n 136-145) mmol/L, K- 3.1(n 3.6-5.1) mmol/L, Cl- 84 (n 90-110) mmol/L, HCO3- 16 (n 22-28) mmol/L, AG- 34 (n 2.6-10.6) mmol/L, B-Hydroxy > 8 (n <0.3) mmol/L -, Lactic Acid- 1.3 (n 0.5-2.2) mmol/L, Serum Osm- 311 (n 280-290) mOsm/Kg . Urine was positive for ketones. PH- on ABG was 7.29 (n 7.350-7.450). Alcohol level was 211(n 0-10) mg/dL. Urine Drug Screen was negative for drugs. Since the patient was euglycemic, IV insulin drip was not initiated and he was presumably treated for starvation and alcohol ketoacidosis with multivitamins , thiamine and D5NS @ 150 mL/hour. Patient was kept NPO, fi Continue reading >>
There is a lot of confusion about the term ketosis among medical professionals as well as laypeople. It is important to understand when and why nutritional ketosis occurs, and why it should not be confused with the metabolic disorder we call ketoacidosis. Ketosis is a metabolic state where the liver produces small organic molecules called ketone bodies. Most cells in the body can use ketone bodies as a source of energy. When there is a limited supply of external energy sources, such as during prolonged fasting or carbohydrate restriction, ketone bodies can provide energy for most organs. In this situation, ketosis can be regarded as a reasonable, adaptive physiologic response that is essential for life, enabling us to survive periods of famine. Nutritional ketosis should not be confused with ketoacidosis, a metabolic condition where the blood becomes acidic as a result of the accumulation of ketone bodies. Ketoacidosis can have serious consequences and may need urgent medical treatment. The most common forms are diabetic ketoacidosis and alcoholic ketoacidosis. What Is Ketosis? The human body can be regarded as a biologic machine. Machines need energy to operate. Some use gasoline, others use electricity, and some use other power resources. Glucose is the primary fuel for most cells and organs in the body. To obtain energy, cells must take up glucose from the blood. Once glucose enters the cells, a series of metabolic reactions break it down into carbon dioxide and water, releasing energy in the process. The body has an ability to store excess glucose in the form of glycogen. In this way, energy can be stored for later use. Glycogen consists of long chains of glucose molecules and is primarily found in the liver and skeletal muscle. Liver glycogen stores are used to mai Continue reading >>
Four Case Studies Of Severe Metabolic Acidosis In Pregnancy
Summarized from Frise C, Mackillop L, Joash K et al. Starvation ketoacidosis in pregnancy. Eur J Obstet Gynecol 2012. Available online ahead of publication at: Arterial blood gas analysis in cases of metabolic acidosis reveals primary decrease in pH and bicarbonate, and secondary (compensatory) reduction in pCO2. The most common cause of metabolic acidosis is increased production of endogenous metabolic acids, either lactic acid, in which case the condition is called lactic acidosis, or keto-acids, in which case the condition is called ketoacidosis. Ketoacidosis most commonly occurs as an acute and life-threatening complication of type I diabetes, due to severe insulin deficiency and resulting reduced glucose availability for energy production within cells (insulin is required for glucose to enter cells). Keto-acids accumulate in blood as a result of metabolism of fats mobilized to fill the energy gap created by reduced availability of glucose within cells. Starvation is also associated with reduced availability of (dietary) glucose and potential for ketoacidosis, although compared with diabetic ketoacidosis, starvation ketoacidosis is rare, usually mild and not life-threatening. Except, that is, when it occurs during pregnancy. In a recently published paper the authors outline four cases of severe starvation ketoacidosis, all occurring in the third trimester of pregnancy, following prolonged vomiting over a period of days. All four women presented for emergency admission in a very poorly state and still vomiting with severe partially compensated metabolic acidosis (bicarbonate in the range of 8-13 mmol/L and base deficit in the range of 14-22 mmol/L). All four required transfer to intensive care and premature delivery of their babies by emergency Cesarean section. Fort Continue reading >>