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Starvation Ketoacidosis Signs And Symptoms

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 >>

Ketones: Clearing Up The Confusion

Ketones: Clearing Up The Confusion

Ketones, ketosis, ketoacidosis, DKA…these are words that you’ve probably heard at one point or another, and you might be wondering what they mean and if you need to worry about them at all, especially if you have diabetes. This week, we’ll explore the mysterious world of ketones, including if and how they may affect you. Ketones — what are they? Ketones are a type of acid that the body can form if there’s not enough carbohydrate to be burned for energy (yes, you do need carbs for fuel). Without enough carb, the body turns to another energy source: fat. Ketones are made in the liver from fat breakdown. This is called ketogenesis. People who don’t have diabetes can form ketones. This might occur if a person does extreme exercise, has an eating disorder, is fasting (not eating), or is following a low-carbohydrate diet. This is called ketosis and it’s a normal response to starvation. In a person who has diabetes, ketones form for the same reason (not enough carb for energy), but this often occurs because there isn’t enough insulin available to help move carb (in the form of glucose) from the bloodstream to the cells to be used for energy. Again, the body scrambles to find an alternate fuel source in the form of fat. You might be thinking that it’s a good thing to burn fat for fuel. However, for someone who has diabetes, ketosis can quickly become dangerous if it occurs due to a continued lack of insulin (the presence of ketones along with “normal” blood sugar levels is not necessarily a cause for concern). In the absence of insulin (which can occur if someone doesn’t take their insulin or perhaps uses an insulin pump and the pump has a malfunction, for example), fat cells continue to release fat into the circulation; the liver then continues to churn Continue reading >>

Ketosis Vs. Ketoacidosis (dka): What Is The Difference?

Ketosis Vs. Ketoacidosis (dka): What Is The Difference?

Let’s break it down so that you can understand exactly what ketosis is and how it differs from ketoacidosis. But the states they refer to are nothing alike. In this case, maybe mistakes are understandable. Many people who believe that ketosis is dangerous are mixing it up with another state called "ketoacidosis." The two words do sound very similar. And some people simply make mistakes. Profit motives tend to muddy up the works when it comes to getting clear, factual information about your health. Well, there are a lot of individuals and companies which all have their own goals and motivations. Where do these misperceptions come from? Here’s the thing though … that is all misinformation. You then Googled something like, "low carb dangerous" and found a list of link-bait articles informing you that low-carb is a ketogenic diet, and ketosis is a dangerous metabolic state which can be fatal. And then maybe someone said something to you like, "What are you thinking? Low-carb is a dangerous diet." If you are thinking about starting a low-carb diet, maybe you have mentioned it to some of your family or friends. By the time you finish reading this article, you will understand why low-carb is a safe diet. Continue reading >>

Fasting Ketosis And Alcoholic Ketoacidosis

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 >>

Starvation Ketoacidosis In Pregnancy

Starvation Ketoacidosis In Pregnancy

Introduction: Starvation ketosis outside pregnancy is a rare phenomenon and is unlikely to cause a severe acidosis. Pregnancy is an insulin resistant state due to placental production of hormones including glucagon and human placental lactogen. Insulin resistance increases with advancing gestation and this confers a susceptibility to ketosis, particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. Ketoacidosis has been associated with intrauterine death. Case report: A 22-year-old woman in her third pregnancy presented at 32 weeks gestation with a 24 h history of severe vomiting. She had been treated for an asthma exacerbation with prednisolone and erythromycin the day prior to presentation. She was unwell, hypertensive (145/70 mmHg) with a sinus tachycardia and Kussmaul breathing. Urinalysis showed ++++ ketones, + protein and pH 5. Fingerprick glucose was 4 mmol/l and ketones were 4.0 mmol/l. Arterial blood gas showed pH 7.27, PaCO2 1.1 kPa, base excess −23, bicarbonate 8.6 mmol/l and lactate 0.6 mmol/l. The anion gap was 20. Serum ethanol, salicylates and paracetamol levels were undetectable. She was fluid resuscitated but her biochemical parameters did not improve. She was intubated and underwent emergency caesarean section. A healthy boy was delivered and her acidosis resolved over the subsequent 8 h. Discussion: We believe this case is explained by starvation ketoacidosis. There was no evidence of diabetes mellitus or other causes of a metabolic acidosis. In view of the hypertension, proteinuria and raised urate the differential diagnosis was an atypical presentation of pre-eclampsia. This case illustrates the metabolic stress imposed by the feto-placental unit. It als Continue reading >>

Ketosis

Ketosis

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 >>

Pregnancy Toxaemia And

Pregnancy Toxaemia And

Contents Industry Background Management Nutrition Animal Health Breeding Fibre Production Fibre Marketing Meat Production and Marketing Pasture and Weed Control Economic Analysis Tanning Skins ketosis in goats The diseases pregnancy toxaemia and ketosis can cause severe problems in goats. While the diseases are clinically different and occur during different stages of pregnancy and lactation, the basis of the disorder is essentially the same: a decrease in blood sugar levels and an increase in ketones. In ruminants, glucose is synthesised mainly from propionic acid (a volatile fatty acid produced in the rumen) and from amino acids. The amount of glucose that is absorbed directly depends on how much dietary carbohydrate escapes rumen fermentation and is digested in the small intestine. This form of glucose uptake varies with different feeds as well as their treatment. Ruminants can use products from rumen fermentation, such as volatile fatty acids, for most of their energy requirements. However, the nervous system, kidneys, mammary gland and foetus have a direct requirement for glucose. During periods of peak glucose requirement (late pregnancy and early lactation) problems may arise due to a glucose deficiency. The incidence of pregnancy toxaemia and ketosis varies with the two main types of goats. In dairy goats with a genetic potential for high milk production, ketosis may be a potential problem; in non-milch goats (Angora, Cashmere and meat) pregnancy toxaemia is more common. PREGNANCY TOXAEMIA Main causes The most important cause of pregnancy toxaemia is a decline in the plane of nutrition during the last six to eight weeks of pregnancy. This places the pregnant female in a difficult situation because the developing foetus imposes an unremitting drain on available m Continue reading >>

The Paleo Guide To Ketosis

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 >>

Extreme Gestational Starvation Ketoacidosis: Case Report And Review Of Pathophysiology

Extreme Gestational Starvation Ketoacidosis: Case Report And Review Of Pathophysiology

A case of severe starvation ketoacidosis developing during pregnancy is presented. The insulinopenic/insulinresistant state found during fasting in late gestation predisposes to ketosis. Superimposition of stress hormones, which further augment lipolysis, exacerbates the degree of ketoacidosis. In our patient, gestational diabetes, twin pregnancies, preterm labor, and occult infection were factors that contributed to severe starvation ketoacidosis. Diagnosis was delayed because starvation ketosis is not generally considered to be a cause of severe acidosis, and because the anion gap was not elevated. Improved understanding of the complex fuel metabolism during pregnancy should aid in prevention, early recognition, and appropriate therapy of this condition. Continue reading >>

Starvation Ketoacidosis As A Cause Of Unexplained Metabolic Acidosis In The Perioperative Period

Starvation Ketoacidosis As A Cause Of Unexplained Metabolic Acidosis In The Perioperative Period

Go to: Abstract Patient: Female, 24 Final Diagnosis: Starvation ketoacidosis Symptoms: None Medication: — Clinical Procedure: Lumbar laminectomy Specialty: Orthopedics and Traumatology Besides providing anesthesia for surgery, the anesthesiologist’s role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient’s perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient’s surgical outcome. Thus, the presence of an acute acid-base disturbance requires a thorough workup, the results of which will influence the patient’s anesthetic management. An otherwise-healthy 24-year-old female presented for elective spine surgery and was found to have metabolic acidosis, hypotension, and polyuria intraoperatively. Common causes of acute metabolic acidosis were investigated and systematically ruled out, including lactic acidosis, diabetic ketoacidosis, drug-induced ketoacidosis, ingestion of toxic alcohols (e.g., methanol, ethylene glycol), uremia, and acute renal failure. Laboratory workup was remarkable only for elevated serum and urinary ketone levels, believed to be secondary to starvation ketoacidosis. Due to the patient’s unexplained acid-base disturbance, she was kept intubated postoperatively to allow for further workup and management. Starvation ketoacidosis is not widely recognized as a perioperative entity, and it is not well described in the medical literature. Lack of anesthesiologist awareness about this disorder may complicate the differential diagnosis for acute intraoperative metabolic acidosi Continue reading >>

Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Starvation Ketoacidosis: A Cause Of Severe Anion Gap Metabolic Acidosis In Pregnancy

Copyright © 2014 Nupur Sinha et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pregnancy is a diabetogenic state characterized by relative insulin resistance, enhanced lipolysis, elevated free fatty acids and increased ketogenesis. In this setting, short period of starvation can precipitate ketoacidosis. This sequence of events is recognized as “accelerated starvation.” Metabolic acidosis during pregnancy may have adverse impact on fetal neural development including impaired intelligence and fetal demise. Short periods of starvation during pregnancy may present as severe anion gap metabolic acidosis (AGMA). We present a 41-year-old female in her 32nd week of pregnancy, admitted with severe AGMA with pH 7.16, anion gap 31, and bicarbonate of 5 mg/dL with normal lactate levels. She was intubated and accepted to medical intensive care unit. Urine and serum acetone were positive. Evaluation for all causes of AGMA was negative. The diagnosis of starvation ketoacidosis was established in absence of other causes of AGMA. Intravenous fluids, dextrose, thiamine, and folic acid were administered with resolution of acidosis, early extubation, and subsequent normal delivery of a healthy baby at full term. Rapid reversal of acidosis and favorable outcome are achieved with early administration of dextrose containing fluids. 1. Introduction A relative insulin deficient state has been well described in pregnancy. This is due to placentally derived hormones including glucagon, cortisol, and human placental lactogen which are increased in periods of stress [1]. The insulin resistance increases with gestational age Continue reading >>

Ketoacidosis

Ketoacidosis

Alcoholic ketoacidosis is a severe metabolic complication due to long-term alcohol consumption. The disease is the accumulation of ketones in the blood. Ketones are the by-product of the body when it breaks down fat for energy. A person who drinks alcohol every day can often be malnourished. One of the main reasons for getting the disease is the clear effects of alcoholism and starvation. In this condition, starvation means the glucose starvation of metabolism. Ketoacidosis from alcoholism should be a tigger that you need to seek alcohol addiction treatment. What causes Alcoholic Ketoacidosis? Long-term very heavy alcohol consumption will cause the disease. Prolonged alcohol abuse may cause malnutrition; the combination of these two may lead to Alcoholic Ketoacidosis. How does the body metabolize? For the body to function properly, the cells need glucose (sugar) and insulin. The body can produce glucose when it digests the food, and the pancreas produces insulin. However, when a person drinks alcohol, the pancreas may stop producing insulin for a brief period. Without insulin, the cell cannot produce glucose for the energy that the body needs. To replenish itself with the energy it will start to burn fat. Once the body turns fat for energy, it will produce ketones. Once the body stops producing insulin for long period due to alcohol intake, ketones will start to accumulate in the bloodstream. This buildup will eventually lead to a severe condition called ketoacidosis. Here are the important events when a person drinks heavy for a long period of time: Also, people who drink too much alcohol may not eat properly and regularly. Most often they vomit frequently because of the alcohol intake. Not eating properly and vomiting may result in starvation. Whenever this happens, t Continue reading >>

Ketoacidosis

Ketoacidosis

GENERAL ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions). ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. a relative or absolute insulin deficiency is present in all cases. CAUSES The three major types of ketosis are: (i) Starvation ketosis (ii) Alcoholic ketoacidosis (iii) Diabetic ketoacidosis STARVATION KETOSIS when hepatic glycogen stores are exhausted (eg after 12-24 hours of total fasting), the liver produces ketones to provide an energy substrate for peripheral tissues. ketoacidosis can appear after an overnight fast but it typically requires 3 to 14 days of starvation to reach maximal severity. typical keto-anion levels are only 1 to 2 mmol/l and this will usually not alter the anion gap. the acidosis even with quite prolonged fasting is only ever of mild to moderate severity with keto-anion levels up to a maximum of 3 to 5 mmol/l and plasma pH down to 7.3. ketone bodies also stimulate some insulin release from the islets. patients are usually not diabetic. ALCOHOLIC KETOSIS Presentation a chronic alcoholic who has a binge, then stops drinking and has little or no oral food intake for a few days (ethanol and fasting) volume depletion is common and this can result in increased levels of counter regulatory hormones (eg glucagon) levels of free fatty acids (FFA) can be high (eg up to 3.5mM) providing plenty of substrate for the altered hepatic lipid metabolism to produce plenty of ketoanions GI symptoms are common (eg nausea, vomiting, abdominal pain, haematemesis, melaena) acidaemia may be severe (eg pH down to 7.0) plasma glucose may be depressed or normal or Continue reading >>

Chapter 220. Diabetic Ketoacidosis

Chapter 220. Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus. The incidence and prevalence of diabetes are rising; as of 2005, an estimated 7% of the U.S. population had diabetes. In patients age 60 or older, the prevalence is estimated to be 20.9%.1 DKA occurs predominately in patients with type 1 (insulin-dependent) diabetes mellitus, but unprovoked DKA can occur in newly diagnosed type 2 (non–insulin-dependent) diabetes mellitus, especially in blacks and Hispanics.2 Between 1993 and 2003, the yearly rate of ED visits for DKA per 10,000 U.S. population with diabetes was 64, with a trend toward an increased rate of visits among the black population compared with the white population.3 Europe has a comparable incidence. A better understanding of pathophysiology and an aggressive, uniform approach to diagnosis and management have reduced mortality to <5% of reported episodes in experienced centers.4 However, mortality is higher in the elderly due to underlying renal disease or coexisting infection and in the presence of coma or hypotension. DKA is a response to cellular starvation brought on by relative insulin deficiency and counterregulatory or catabolic hormone excess (Figure 220-1). Insulin is the only anabolic hormone produced by the endocrine pancreas and is responsible for the metabolism and storage of carbohydrates, fat, and protein. Counterregulatory hormones include glucagon, catecholamines, cortisol, and growth hormone. Complete or relative absence of insulin and the excess counterregulatory hormones result in hyperglycemia (due to excess production and underutilization of glucose), osmotic diuresis, prerenal azotemia, worsening hyperglycemia, ketone formation, and a wide-anion gap metabolic acidosis.4 Insulin deficiency. Patho Continue reading >>

Ketosis Explained – For Weight Loss, Health Or Performance

Ketosis Explained – For Weight Loss, Health Or Performance

Get Started Ketosis is a natural state for the body, when it is almost completely fueled by fat. This is normal during fasting, or when on a strict low-carb diet. Ketosis has many potential benefits, but there are also side effects. In type 1 diabetes and certain other rare situations excessive ketosis can even become dangerous. On this page you can learn all about how to harness the benefits of ketosis, while avoiding any problems. It all starts with understanding what ketosis is. Choose a section, or keep reading below for all of them. Ketosis ExplainedKetosis Explained BenefitsBenefits How to Get Into KetosisHow to Get Into Ketosis Ketosis ExplainedSymptoms & How to Know You’re In Ketosis Side Effects, Fears & Potential DangersSide Effects, Fears & Potential Dangers How to Reach Optimal KetosisHow to Reach Optimal Ketosis ketones Ketosis Explained The “keto” in the word ketosis comes from the fact that it makes the body produce small fuel molecules called “ketones”.1 This is an alternative fuel for the body, used when blood sugar (glucose) is in short supply. Ketones are produced if you eat very few carbs (that are broken down into blood sugar) and only moderate amounts of protein (excess protein can be converted to blood sugar). Ketones are produced in the liver, from fat. They are then consumed as fuel in the body, including by the brain. This is important as the brain is a hungry organ that consumes lots of energy every day,2 and it can’t run on fat directly. It can only run on glucose… or ketones. Maximizing fat burning On a ketogenic diet your entire body switches its fuel supply to run almost entirely on fat. Insulin levels become very low and fat burning increases dramatically. It becomes easy to access your fat stores to burn them off. This is o Continue reading >>

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