diabetestalk.net

Starvation Ketoacidosis Symptoms

Ketosis

Ketosis

Tweet Ketosis is a state the body may find itself in either as a result of raised blood glucose levels or as a part of low carb dieting. Low levels of ketosis is perfectly normal. However, high levels of ketosis in the short term can be serious and the long term effects of regular moderate ketosis are only partially known at the moment. What is ketosis? Ketosis is a state the body goes into if it needs to break down body fat for energy. The state is marked by raised levels of ketones in the blood which can be used by the body as fuel. Ketones which are not used for fuel are excreted out of the body via the kidneys and the urine. Is ketosis the same as ketoacidosis? There is often confusion as to the difference between ketosis and ketoacidosis. Ketosis is the state whereby the body is producing ketones. In ketosis, the level of ketones in the blood can be anything between normal to very high. Diabetic ketoacidosis, also known as DKA, only describes the state in which the level of ketones is either high or very high. In ketoacidosis, the amount of ketones in the blood is sufficient to turn the blood acidic, which is a dangerous medical state. When does ketosis occur? Ketosis will take place when the body needs energy and there is not sufficient glucose available for the body. This can typically happen when the body is lacking insulin and blood glucose levels become high. Other causes can be the result of being on a low carb diet. A low level of carbohydrate will lead to low levels of insulin, and therefore the body will produce ketones which do not rely on insulin to get into and fuel the body’s cells. A further cause of ketosis, less relevant to people with diabetes, is a result of excessive alcohol consumption. Is ketosis dangerous? The NHS describes ketosis as a pote Continue reading >>

The 4 Ketosis Symptoms You Should Be Looking For

The 4 Ketosis Symptoms You Should Be Looking For

Ketosis is the condition in which your body begins burning fat instead of carbs for its energy source. The benefits of ketosis range widely, but some of the best include: fat loss increased endurance less cravings shredded physique neurological optimization But how do you know when you’re in ketosis? Are there symptoms that you’re in ketosis? Is there a way to “feel” like you’re in ketosis? Obviously the best way to see if you’re in ketosis is to test you breath, blood, or urine. However, we’ve constructed the following list to help you detect the signs that you’ve transitioned into ketosis and turned your body into a fat burning machine! If you’ve been on the Ketogenic Diet for at least a week, run through this list of ketosis symptoms, and see if they fit what you’re experiencing! 1. Ketosis Breath A popular report from many low-carb and keto dieters is that their breath is less than desirable. The smell has been compared to fingernail polish remover, which is believed to come from the presence of acetone. Acetone is, of course, a ketone body, and is also found in many brands of nail-polish remover. 2. Keto Flu After a life full of ingesting large portions of carbs for energy, dropping carbs and moving into ketosis can often result in ketosis symptoms known collectively as the “keto flu.” It’s not unheard to feel light-headed, fatigued, or anemic when your body runs out of carb stores and begins turning to fat for its fuel source. You might feel irritable, or short-tempered; this is your body’s natural reaction to having sugar removed. Much like an addict in rehab, when you cut out mass amounts of processed sugars, you turn into a bit of a monster. Ketosis symptoms also include nausea, or stomach aches. These can be caused by your stomach r Continue reading >>

Diabetic, Alcoholic And Starvation Ketoacidosis

Diabetic, Alcoholic And Starvation Ketoacidosis

Copious amounts of ketones which are generated in insulin-deficient or insulin-unresponsive patients will give rise to a high anion gap metabolic acidosis. Ketones are anions, and they form the high anion gap. Management of DKA and HONK is discussed elsewhere. Meet the ketones Chemically speaking, a ketone is anything with a carbonyl group between a bunch of other carbon atoms. The above are your three typical ketoacidosis-associated ketone bodies. The biochemistry nerds among us will hasten to add that the beta-hydroxybutyrate is in fact not a ketone but a carboxylic acid, but - because it is associated with ketoacidosis, we will continue to refer to it as a ketone for the remainder of this chapter, in the spirit of convention. In the same spirit, we can suspend our objections to acetone being included in a discussion of ketoacidosis, which (though a true ketone) is in fact not acidic or basic, as it does not ionise at physiological pH (its pKa is 20 or so). So really, the only serious ketone acid is acetoacetate, which has a pKa of 3.77. However, beta-hydroxybutyrate is the prevalent ketone in ketoacidosis; the normal ratio of beta-hydroxybutyrate and acetoacetate is 3:1, and it can rise to 10:1 in diabetic ketoacidosis. Acetone is the least abundant. The metabolic origin of ketones The generation of ketones is a normal response to fasting, which follows the depletion of hepatic glycogen stores. Let us discuss normal physiology for a change. You, a healthy adult without serious alcohol problems, are fasting from midnight for a routine elective hernia repair. You will go to be after dinner with a few nice lumps of undigested food in your intestine, as well as about 75g of hepatic glycogen. As you sleep, you gradually digest the food and dip into the glycogen store. At Continue reading >>

The Difference Between Ketosis And Ketoacidosis

The Difference Between Ketosis And Ketoacidosis

When you hear these two terms it’s easy to see how they can be confused. The confusion also stems from the fact that the two are both metabolic processes involving the breakdown of fats in the body (plus they look and sound like similar words). The truth is ketosis and ketoacidosis are two completely different things. Ketosis and the Ketogenic Diet Ketosis is a normal metabolic process in which the body has a high fat-burning rate. It is a healthy and natural state your body enters when your body is running on fat rather than glucose1. The state of ketosis occurs when ketone levels are raised in the blood due to the conversion of fats into fatty acids and ketones. This happens when the body runs out of carbohydrates – usually because a person hasn’t eaten in a while, for example during fasts, or they eat a very low-carbohydrate diet – leaving little sugar to convert into glycogen. Without glycogen, the body breaks down fat cells for energy. A low-carb, high fat diet, also known as a ketogenic diet, is necessary to enter and stay in ketosis long-term. When you eat a low-carbohydrate diet, your body enters the metabolic state of ketosis within 2 days but it can vary from person to person. There are many benefits2 to being in longer-term ketosis including: lowered triglycerides levels no spikes in blood glucose levels greater mental clarity lowered blood pressure and cholesterol reduced food and sugar cravings weight loss Ketoacidosis – The Body in a State of Toxicity Ketoacidosis is a metabolic state of toxicity. It occurs when the body fails to regulate ketone production resulting in severe accumulation of keto acids which cause the pH of the blood to decrease substantially making the blood more acidic. The most common causes for ketoacidosis are Type 1 Diabete 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 >>

Euglycemic Diabetic Ketoacidosis: An Easily Missed Diagnosis

Euglycemic Diabetic Ketoacidosis: An Easily Missed Diagnosis

SESSION TITLE: Critical Care Student/Resident Case Report Posters I SESSION TYPE: Student/Resident Case Report Poster INTRODUCTION: A 47 year-old woman with type 1 diabetes presented with euglycemic diabetic ketoacidosis (DKA) that initially went undiagnosed. Recognition and treatment with insulin resulted in rapid resolution of her clinical condition. CASE PRESENTATION: A 47 year-old woman presented to our hospital with four days of fever, abdominal pain, diarrhea, nausea, vomiting, lethargy and malaise. She had a history of type 1 diabetes mellitus managed with an insulin pump. Her blood pressure was 88/51. She was disoriented with a diffusely tender but soft abdomen. Laboratory studies revealed blood glucose of 109 mg/dL, bicarbonate of 15 mmol/L, anion gap of 27 mmol/L, lactic acid of 2.4 mmol/L, and a bandemia of 11%. Rapid flu test was positive. She was admitted to the intensive care unit, resuscitated with intravenous fluid, and started on oseltamivir, cefepime and vancomycin. Hemodialysis was initiated soon thereafter. The patient received no insulin due to her euglycemia. Influenza A was detected by PCR on the second hospital day and antibiotics were discontinued. Her gastrointestinal symptoms improved but her mental status remained poor. Furthermore, while her lactate normalized and blood glucose remained under 120 mg/d, her anion gap persisted at 23-36 mmol/L and her bicarbonate remained low at 15-17 mmol/L. Beta hydroxybutyrate was found to be 4.88 mmol/L. An insulin infusion was started, along with dextrose 5% in water, and her mental status rapidly improved as her acidemia and anion gap normalized. DISCUSSION: Euglycemic DKA is a rare condition that can easily go undiagnosed. It has been previously described in the context of critical illness.1 The pathoge Continue reading >>

Ketoacidosis Vs. Ketosis: What's The Difference?

Ketoacidosis Vs. Ketosis: What's The Difference?

You may have heard the term "keto" or ketogenic floating around. So what exactly is ketoacidosis, ketosis and ketones? Here, we break it down for you. "Keto" is derived from the word ketone, a specific class of organic compounds in your body that are produced when your body burns fat instead of carbohydrates. Your body prefers to burn carbohydrates (glucose) for energy. However, if there is not enough glucose to burn, you will start burning fat instead. This process is called ketosis. Ketones circulate in the bloodstream and are used by tissues and muscles for fuel. You will excrete any ketones not used for energy in your urine. Don't Miss: Healthy Low-Carb Recipes Ketosis vs. Ketoacidosis "Ketosis is simply the presence of ketones in the blood," says Staci Freeworth, R.D., C.D.E., professor of nutrition at Bowling Green State University. "This can be caused by periods of energy imbalance, a change in diet, pregnancy or overconsumption of alcohol." Ketosis is a normal response in the body when a healthy person with a balanced diet starts fasting or severely restricting calories or carbohydrates (e.g., the super low-carb ketogenic diet). Ketosis happens when the body senses a state of starvation. Ketoacidosis is when blood levels of ketones are so high that your blood becomes too acidic. "Ketoacidosis is short for diabetic ketoacidosis and occurs in diabetics who do not make insulin or stop taking their prescribed insulin, typically people with type 1 diabetes," Freeworth says. It can lead to a diabetic coma or even death, according to the American Diabetes Association. Insulin helps transport your blood glucose (or blood sugar) to your cells and tissues. People with type 1 diabetes, and some people with type 2 diabetes, have to inject insulin because their bodies do not Continue reading >>

Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation

Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation

Abstract Ketoacidosis is a potential complication of type 1 diabetes. Severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. Three weeks after delivery, a young woman was admitted because of tachypnoe and tachycardia. Blood gas analysis showed a severe metabolic acidosis with a high anion gap. Further workup revealed the presence of ketone bodies in the urine with normal blood glucose and no history of diabetes. The patient reported that she had not eaten for days because of abdominal pain. After initial treatment in the ICU and immediate re-feeding, the patient’s condition rapidly improved. While under normal circumstances fasting causes at most only mild acidosis, it can be dangerous during lactation. Prolonged fasting in combination with different forms of stress puts breast feeding women at risk for starvation ketoacidosis and should therefore be avoided. Background Severe acidosis is a potentially life-threatening condition. In case of metabolic acidosis, determination of the serum anion gap helps to narrow down the differential diagnosis. An increased anion gap indicates the presence of an unusual amount of an acid that is most commonly found in ketoacidosis, lactic acidosis, renal insufficiency, and intoxications while other causes are rare. Ketoacidosis is a potential complication of type 1 diabetes while severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. In diabetic ketoacidosis, glucose is not properly taken up into tissue due to an absolute insulin deficiency that is mainly found in type 1 diabetes. In parallel, glucagon release is not suppressed leading to hyperglucagonemia. Subsequently the body activates stress hormones, which worsen hyperglycemia by promoting gluconeogenesis (and also ketog Continue reading >>

What Is Ketosis, And How Long Does It Take To Get Into Ketosis?

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 >>

Ketosis: Symptoms, Signs & More

Ketosis: Symptoms, Signs & More

Every cell in your body needs energy to survive. Most of the time, you create energy from the sugar (glucose) in your bloodstream. Insulin helps regulate glucose levels in the blood and stimulate the absorption of glucose by the cells in your body. If you don’t have enough glucose or insufficient insulin to get the job done, your body will break down fat instead for energy. This supply of fat is an alternative energy source that keeps you from starvation. When you break down fat, you produce a compound called a ketone body. This process is called ketosis. Insulin is required by your cells in order to use the glucose in your blood, but ketones do not require insulin. The ketones that don’t get used for energy pass through your kidneys and out through your urine. Ketosis is most likely to occur in people who have diabetes, a condition in which the body produces little or no insulin. Ketosis and Ketoacidosis: What You Need To Know Ketosis simply means that your body is producing ketone bodies. You’re burning fat instead of glucose. Ketosis isn’t necessarily harmful to your health. If you don’t have diabetes and you maintain a healthy diet, it’s unlikely to be a problem. While ketosis itself isn’t particularly dangerous, it’s definitely something to keep an eye on, especially if you have diabetes. Ketosis can be a precursor to ketoacidosis, also known as diabetic ketoacidosis. Ketoacidosis is a condition in which you have both high glucose and high ketone levels. Having ketoacidosis results in your blood becoming too acidic. It’s more common for those with type 1 diabetes rather than type 2. Once symptoms of ketoacidosis begin, they can escalate very quickly. Symptoms include: breath that smells fruity or like nail polish or nail polish remover rapid breat 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 >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Increased production of ketone bodies due to: Dehydration (nausea/vomiting, ADH inhibition) leads to increased stress hormone production leading to ketone formation Depleted glycogen stores in the liver (malnutrition/decrease carbohydrate intake) Elevated ratio of NADH/NAD due to ethanol metabolism Increased free fatty acid production Elevated NADH/NAD ratio leads to the predominate production of β–hydroxybutyrate (BHB) over acetoacetate (AcAc) Dehydration Fever absent unless there is an underlying infection Tachycardia (common) due to: Dehydration with associated orthostatic changes Concurrent alcohol withdrawal Tachypnea: Common Deep, rapid, Kussmaul respirations frequently present Nausea and vomiting Abdominal pain (nausea, vomiting, and abdominal pain are the most common symptoms): Usually diffuse with nonspecific tenderness Epigastric pain common Rebound tenderness, abdominal distension, hypoactive bowel sounds uncommon Mandates a search for an alternative, coexistent illness Decreased urinary output from hypovolemia Mental status: Minimally altered as a result of hypovolemia and possibly intoxication Altered mental status mandates a search for other associated conditions such as: Head injury, cerebrovascular accident (CVA), or intracranial hemorrhage Hypoglycemia Alcohol withdrawal Encephalopathy Toxins Visual disturbances: Reports of isolated visual disturbances with AKA common History Chronic alcohol use: Recent binge Abrupt cessation Physical Exam Findings of dehydration most common May have ketotic odor Kussmaul respirations Palmar erythema (alcoholism) Lab Acid–base disturbance: Increased anion gap metabolic acidosis hallmark Mixed acid–base disturbance common: Respiratory alkalosis Metabolic alkalosis secondary to vomiting and dehydration Hyperchlorem Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Differential Diagnosis Disease/Condition Differentiating Signs/Symptoms Differentiating Tests Hyperosmolar hyperglycemic state (HHS) Patients are typically older than patients with DKA and are usually patients with type 2 diabetes. Older nursing home residents with poor fluid intake are at high risk. Symptoms evolve insidiously over days to weeks. Mental obtundation and coma are more frequent. Focal neurologic signs (hemianopia and hemiparesis) and seizures are also seen. Seizures may be the dominant clinical features. [1] Serum glucose is >600 mg/dL. Serum osmolality is usually >320 mOsm/kg. Urine ketones are normal or only mildly positive. Serum ketones are negative. Anion gap is variable but typically <12 mEq/L. Total chloride deficit is 5 to 15 mEq/kg. ABG: arterial pH is typically >7.30, whereas in DKA it ranges from 7.00 to 7.30. Arterial bicarbonate is >15 mEq/L. Lactic acidosis The presentation is identical to that of DKA. In pure lactic acidosis, the serum glucose and ketones should be normal and the serum lactate concentration should be elevated. Serum lactate >5 mmol/L. [1] Starvation ketosis Starvation ketosis results from inadequate carbohydrate availability resulting in physiologically appropriate lipolysis and ketone production to provide fuel substrates for muscle. The blood glucose is usually normal. Although the urine can have large amounts of ketones, the blood rarely does. Arterial pH is normal and the anion gap is at most mildly elevated. [1] Alcoholic ketoacidosis Classically, these patients are long-standing alcoholic people for whom ethanol has been the main caloric source for days to weeks. The ketoacidosis occurs when for some reason alcohol and caloric intake decreases. In isolated alcoholic ketoacidosis, the metabolic acidosis is usually mild Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis Damian Baalmann, 2nd year EM resident A 45-year-old male presents to your emergency department with abdominal pain. He is conscious, lucid and as the nurses are hooking up the monitors, he explains to you that he began experiencing abdominal pain, nausea, vomiting about 2 days ago. Exam reveals a poorly groomed male with dry mucous membranes, diffusely tender abdomen with voluntary guarding. He is tachycardic, tachypneic but normotensive. A quick review of the chart reveals a prolonged history of alcohol abuse and after some questioning, the patient admits to a recent binge. Pertinent labs reveal slightly elevated anion-gap metabolic acidosis, normal glucose, ethanol level of 0, normal lipase and no ketones in the urine. What are your next steps in management? Alcoholic Ketoacidosis (AKA): What is it? Ketones are a form of energy made by the liver by free fatty acids released by adipose tissues. Normally, ketones are in small quantity (<0.1 mmol/L), but sometimes the body is forced to increase its production of these ketones. Ketones are strong acids and when they accumulate in large numbers, their presence leads to an acidosis. In alcoholics, a combination or reduced nutrient intake, hepatic oxidation of ethanol, and dehydration can lead to ketoacidosis. Alcoholics tend to rely on ethanol for their nutrient intake and when the liver metabolizes ethanol it generates NADH. This NADH further promotes ketone formation in the liver. Furthermore, ethanol promotes diuresis which leads to dehydration and subsequently impairs ketone excretion in the urine. Alcoholic Ketoacidosis: How do I recognize it? Typical history involves a chronic alcohol abuser who went on a recent binge that was terminated by severe nausea, vomiting, and abdominal pain. These folk Continue reading >>

Kids And Ketones: Checking And Treating High Blood Glucose

Kids And Ketones: Checking And Treating High Blood Glucose

Low blood glucose levels usually have warning signs such as shaking, sweating and rapid heartbeat, but high blood glucose levels can be silent until things start to get out of control. The staff in the Joslin Pediatic Clinic has this advice. One of the vital warning signs of an impending diabetic crisis is the appearance of ketones in the blood or urine. For children with type 1 diabetes and their parents, understanding the role of ketones in a diabetic emergency and knowing how to check for them and what to do if your child has them can mean the difference between a good night’s sleep and many tense hours in the emergency room. (Ketoacidosis almost always occurs in people with type 1 diabetes) Too little insulin for too long a time initiates a cascade of hormonal changes in the body that can lead to the dangerous condition of diabetic ketoacidosis (DKA). If left untreated, it can lead to coma and death. In the face of inadequate circulating insulin, glucose builds up in the blood instead of moving into the tissue cells where it would be used for fuel. Without glucose to burn for energy, the body turns to fat for fuel. The special type of fat it uses is called ketones. Because ketones are an acid, the body needs to supply a base (the opposite of an acid) to neutralize their effects and maintain the blood’s natural pH. However, the body’s supply of base,such as NH3 (anydrous ammonia) (is limited and at some point the system is overwhelmed and the blood pH starts to decline. This drop in blood pH is one of reasons ketoacidosis is so serious. The body can’t accommodate changes in blood pH well. Illness can often be a precipitating cause of DKA. Infection can spike glucose levels and additional insulin is often required. If the needs for additional insulin aren’t Continue reading >>

More in ketosis