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Why Do Ketone Bodies Cause Acidosis?

Metabolic Acidosis

Metabolic Acidosis

I have been trying to find out what metabolic acidosis is and what causes it. I guess I just don't understand what it is. If anyone can explain to me in plain English I would appreciate it. We the willing, following the unknowing are doing the impossible. We have done so much for so long with so little that we are now able to do anything with nothing. Metabolic Acidosis is caused by your body pH (blood and bodily fluids) becoming more acidic. Your body has 3 systems (buffers) in place to keep your pH tightly regulated, but there are times when it can become more acidic which can be dangerous. For diabetics, the breakdown of fat and protein produces things called ketone bodies, which are acidic. The buildup of ketone bodies therefore causes your body pH to become more acidic which can lead to acidosis. When you have acidosis due to a high level of ketones it is called ketoacidosis and since it is seen commonly in diabetics it is commonly called diabetic ketoacidosis or DKA. It also occurs in starvation. You can develop ketones from a low carb diet since the primary source then becomes fat and protein, but it's not ketones themselves which are dangerous, but a buildup of ketones. Insulin shuts down the production of ketones since it inhibits the breakdown of fat, so if you have sufficient insulin your chances of developing DKA are slim This is why it is most commonly seen in T1 diabetics, since they have no insulin to protect them from it. It is less likely, but not impossible to develop in people who still produce insulin. Insulin (avg): 19.8 U (35% bolus); CHO (avg): 87g; BG (avg): 97 mg/dl; SD: 31 Tests (avg): 5.1; High: 168; Low: 51; highs>140: 3; lows<70: 10 Continue reading >>

Diabetes With Ketone Bodies In Dogs

Diabetes With Ketone Bodies In Dogs

Diabetes Mellitus with Ketoacidosis in Dogs Diabetes is a medical condition in which the body cannot absorb sufficient glucose, thus causing a rise the blood sugar levels. The term “ketoacidosis,” meanwhile, refers to a condition in which levels of acid abnormally increased in the blood due to presence of “ketone bodies”. In diabetes with ketoacidosis, ketoacidosis immediately follows diabetes. It should be considered a dire emergency, one in which immediate treatment is required to save the life of the animal. This condition typically affects older dogs as well as females. In addition, miniature poodles and dachshunds are predisposed to diabetes with ketoacidosis. Symptoms and Types Weakness Lethargy Depression Lack of appetite (anorexia) Muscle wasting Rough hair coat Dehydration Dandruff Sweet breath odor Causes Although the ketoacidosis is ultimately brought on by the dog's insulin dependency due to diabetes mellitus, underlying factors include stress, surgery, and infections of the skin, respiratory, and urinary tract systems. Concurrent diseases such as heart failure, kidney failure, asthma, cancer may also lead to this type of condition. Diagnosis You will need to give a thorough history of your dog’s health, including the onset and nature of the symptoms, to your veterinarian. He or she will then perform a complete physical examination, as well as a biochemistry profile and complete blood count (CBC). The most consistent finding in patients with diabetes is higher than normal levels of glucose in the blood. If infection is present, white blood cell count will also high. Other findings may include: high liver enzymes, high blood cholesterol levels, accumulation in the blood of nitrogenous waste products (urea) that are usually excreted in the urine (azo Continue reading >>

Acidosis

Acidosis

The kidneys and lungs maintain the balance (proper pH level) of chemicals called acids and bases in the body. Acidosis occurs when acid builds up or when bicarbonate (a base) is lost. Acidosis is classified as either respiratory or metabolic acidosis. Respiratory acidosis develops when there is too much carbon dioxide (an acid) in the body. This type of acidosis is usually caused when the body is unable to remove enough carbon dioxide through breathing. Other names for respiratory acidosis are hypercapnic acidosis and carbon dioxide acidosis. Causes of respiratory acidosis include: Chest deformities, such as kyphosis Chest injuries Chest muscle weakness Chronic lung disease Overuse of sedative drugs Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body. There are several types of metabolic acidosis: Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes. Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea. Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Lactic acidosis is a buildup of lactic acid. Lactic acid is mainly produced in muscle cells and red blood cells. It forms when the body breaks down carbohydrates to use for energy when oxygen levels are low. This can be caused by: Cancer Drinking too much alcohol Exercising vigorously for a very long time Liver failure Low blood sugar (hypoglycemia) Medications, such as salicylates MELAS (a very rare genetic mitochondrial disorder that affects energy production) Prolonged lack of oxygen from shock, heart failure, or seve Continue reading >>

What Are Ketones And What Do They Have To Do With Diabetes?

What Are Ketones And What Do They Have To Do With Diabetes?

People with Type 1 Diabetes, or people with advanced Type 2 Diabetes, do not produce, enough, or any Insulin at all and Insulin is a pancreas produced hormone that is required to metabolise the blood sugar and when the body has insufficient Insulin, it cannot get glucose from the blood into the body's cells to use as energy. Glucose is the primary fuel that the body uses for energy and a lack of energy makes the body think that you do not have enough glucose present in the blood, so the body starts to burn body fat in order to create more glucose; however, this does not create more Insulin and so the body still cannot get glucose from the blood into the body's cells to use as energy; this creates a vicious circle, in which the body burns even more fat. Unfortunately, when the body burns too much fat, it also creates Ketones, which is an acid that is released into the bloodstream and if there is insufficient Insulin present to help fuel the body’s cells, the Keytones start to build up; therefore, high levels of Ketones are more common in people with Type 1 Diabetes, or people with advanced Type 2 Diabetes. The Symptoms Of Ketoacidosis: Symptoms of Ketoacidosis include Slow, Deep Breathing; Ketones give the breath a sickly, fruity odour like nail varnish remover or pear drops; Confusion; Frequent Urination 'Polyuria'; Poor Appetite and eventually Loss of Consciousness; a good indication is if you can taste nail varnish or pear drops when licking your lips. How Do I Test For Ketones? Ketone testing can be carried out at home; there are several products that test for Ketones in the urine and there are blood glucose meters which can also test for Ketones as well as test the blood glucose levels; although, you will probably only need to use ketone testing if you are ill or Continue reading >>

Getting To Know Ketones

Getting To Know Ketones

People with diabetes, particularly those with Type 1 diabetes, have been at least vaguely aware of the word ketones for a long time. With the recent resurgence of popular interest in low-carbohydrate diets, however, just about everyone seems to be talking about ketones these days. But does anyone really know what ketones are? Are they a danger to your health (as in diabetic ketoacidosis), or a sign that you have lowered your carbohydrate intake enough to cause weight loss (as some people who follow low-carbohydrate diets believe)? What are ketones? Ketones are end-products of fat metabolism in the body. That is, they are formed when fat is burned for energy by the muscles. Chemically, they are acids known as ketone bodies, and there are three types: beta-hydroxybutyric acid, aceto-acetic acid, and acetone. But you don’t have to be a chemist to understand what role they play in the body. To get to know ketones, it’s helpful to understand how your body burns fuel. A simple analogy is that of an automobile. For a car engine to run, the engine must burn fuel (gasoline), and when the fuel is burned, exhaust (carbon monoxide) is created. The carbon monoxide is the end-product of gasoline combustion. Your body also has an engine that must burn fuel to operate. The engine is muscle, and the fuel is fat, carbohydrate (glucose), and, in certain conditions, protein. When fat is burned, the “exhaust” is ketones, and when glucose is burned, the “exhaust” is lactic acid. Fat is more desirable as a fuel than glucose because there are more calories in a gram of fat (9 calories per gram) than there are in a gram of glucose (4 calories per gram), so you get more energy per gram of fat burned. In a sense, you could call fat a high-test fuel. But there is one catch to burning f 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 >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Background In 1940, Dillon and colleagues first described alcoholic ketoacidosis (AKA) as a distinct syndrome. AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels, and a normal or low glucose concentration. [1, 2] Although AKA most commonly occurs in adults with alcoholism, it has been reported in less-experienced drinkers of all ages. Patients typically have a recent history of binge drinking, little or no food intake, and persistent vomiting. [3, 4, 5] A concomitant metabolic alkalosis is common, secondary to vomiting and volume depletion (see Workup). [6] Treatment of AKA is directed toward reversing the 3 major pathophysiologic causes of the syndrome, which are: This goal can usually be achieved through the administration of dextrose and saline solutions (see Treatment). Continue reading >>

Is Ketosis Dangerous?

Is Ketosis Dangerous?

You may have heard from your doctor that ketosis is a life-threatening condition. If so, your doctor is confusing diabetic ketoacidosis (DKA) with nutritional ketosis, or keto-adaptation. First, some semantics. Our body can produce, from fat and some amino acids, three ketone bodies (a “ketone” refers to the chemical structure where oxygen is double-bonded to carbon sandwiched between at least 2 other carbons). These ketone bodies we produce are: acetone, acetoacetone, and beta-hydroxybutyrate (B-OHB). [For anyone who is interested, they are the 3 most right structures on the figure, below.] Why do we make ketones? For starters, it’s a vital evolutionary advantage. Our brain can only function with glucose and ketones. Since we can’t store more than about 24 hours’ worth of glucose, we would all die of hypoglycemia if ever forced to fast for more than a day. Fortunately, our liver can take fat and select amino acids (the building blocks of proteins) and turn them into ketones, first and foremost to feed our brains. Hence, our body’s ability to produce ketones is required for basic survival. What is diabetic ketoacidosis? When diabetics (usually Type I diabetics, but sometimes this occurs in very late-stage, insulin-dependent, Type II diabetics) fail to receive enough insulin, they go into an effective state of starvation. While they may have all the glucose in the world in their bloodstream, without insulin, they can’t get any into their cells. Hence, they are effectively going into starvation. The body does what it would do in anyone – it starts to make ketones out of fat and proteins. Here’s the problem: the diabetic patient in this case can’t produce any insulin, so there is no feedback loop and they continue to produce more and more ketones withou Continue reading >>

Medcram Medical Education Blog

Medcram Medical Education Blog

Were gonna talk about diabetic ketoacidosis DKA. DKA is a pretty significant illness that accounts for about 135.000 hospital admissions every year in the United States and it has an estimated cost of about 2.4 billion US dollars every year. So, a pretty sizeable chunk of cash is used to treat these patients and so, it behooves us to understand a little bit more about what is DKA, how does it present and how to treat it. First, I want to take you to the cellular level. Over here, I will show you our cell wall and on it, its got an insulin receptor. Also, inside the cell, you recall that we have mitochondria and youll recall that there is an inner-membrane space, along with the matrix. The matrix is that inner part. Now, remember where things are. Youve got glucose outside the cell, that wants to move inside, and youve got fatty acids as well. Well draw a fatty acid here. You recall that this is where Krebs cycle occurs; Ill abbreviate that as KC. This is where you have beta-oxidation. Remember these? Fatty acids move inside the cell. Youll also recall that glucose, once it gets inside the cell, is going to undergo glycolysis and it will also go inside the cell in the form of pyruvate, which will eventually get broken down to the same product and enter Krebs Cycle as Acetyl-CoA. In the normal situation, youve got insulin. Insulin binds to its receptor and insulin also prevents, for the most part, fatty acids from moving on into the cell for the process of beta-oxidation. So, in the normal situation, youve got insulin hitting a receptor, causing glucose to go into the cell, glycolysis is occurring and the end result is pyruvate; pyruvate then moves into the mitochondria, Krebs Cycle occurs and you get, boom, ATP. In the situation with diabetes mellitus type 1, where you Continue reading >>

Ketone Body Metabolism

Ketone Body Metabolism

Ketone body metabolism includes ketone body synthesis (ketogenesis) and breakdown (ketolysis). When the body goes from the fed to the fasted state the liver switches from an organ of carbohydrate utilization and fatty acid synthesis to one of fatty acid oxidation and ketone body production. This metabolic switch is amplified in uncontrolled diabetes. In these states the fat-derived energy (ketone bodies) generated in the liver enter the blood stream and are used by other organs, such as the brain, heart, kidney cortex and skeletal muscle. Ketone bodies are particularly important for the brain which has no other substantial non-glucose-derived energy source. The two main ketone bodies are acetoacetate (AcAc) and 3-hydroxybutyrate (3HB) also referred to as β-hydroxybutyrate, with acetone the third, and least abundant. Ketone bodies are always present in the blood and their levels increase during fasting and prolonged exercise. After an over-night fast, ketone bodies supply 2–6% of the body's energy requirements, while they supply 30–40% of the energy needs after a 3-day fast. When they build up in the blood they spill over into the urine. The presence of elevated ketone bodies in the blood is termed ketosis and the presence of ketone bodies in the urine is called ketonuria. The body can also rid itself of acetone through the lungs which gives the breath a fruity odour. Diabetes is the most common pathological cause of elevated blood ketones. In diabetic ketoacidosis, high levels of ketone bodies are produced in response to low insulin levels and high levels of counter-regulatory hormones. Ketone bodies The term ‘ketone bodies’ refers to three molecules, acetoacetate (AcAc), 3-hydroxybutyrate (3HB) and acetone (Figure 1). 3HB is formed from the reduction of AcAc 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 >>

The Pathophysiology Of Diabetic Ketoacidosis

The Pathophysiology Of Diabetic Ketoacidosis

People still die from diabetic ketoacidosis. Poor patient education is probably the mostimportant determinant of the incidence of the catastrophe that constitutes "DKA".In several series, only about a fifth of patients with DKA are first-time presenterswith recently acquired Type I diabetes mellitus. The remainder are recognised diabeticswho are either noncompliant with insulin therapy, or have serious underlying illess thatprecipitates DKA. Most such patients have type I ("insulin dependent", "juvenile onset") diabetes mellitus, but it has recently been increasingly recognised that patients with type II diabetes mellitusmay present with ketoacidosis, and that some such patients present with "typical hyperosmolar nonketotic coma", but on closer inspection have varying degrees of ketoacidosis. DKA is best seen as a disorder that follows on an imbalance between insulin levels andlevels of counterregulatory hormones. Put simply: "Diabetic ketoacidosis is due to a marked deficiency of insulin in the face of high levels of hormones thatoppose the effects of insulin, particularly glucagon. Even small amounts of insulin can turn off ketoacid formation". Many hormones antagonise the effects of insulin. These include: In addition, several cytokines such as IL1, IL6 and TNF alpha antagonise the effects ofinsulin. [J Biol Chem 2001 Jul 13;276(28):25889-93]It is thus not surprising that many causes of stress and/or the systemic inflammatory response syndrome,appear to precipitate DKA in patients lacking insulin. Mechanisms by which these hormones and cytokinesantagonise insulin are complex, including inhibition of insulin release (catecholamines), antagonistic metaboliceffects (decreased glycogen production, inhibition of glycolysis), and promotion of peripheral resistance tothe e Continue reading >>

Acidosis - Scripps Health

Acidosis - Scripps Health

Acidosis is a condition in which there is too much acid in the body fluids. It is the opposite of alkalosis (a condition in which there is too much base in the body fluids). The kidneys and lungs maintain the balance (proper pH level) of chemicals called acids and bases in the body. Acidosis occurs when acid builds up or when bicarbonate (a base) is lost. Acidosis is classified as either respiratory or metabolic acidosis . Respiratory acidosis develops when there is too much carbon dioxide (an acid) in the body. This type of acidosis is usually caused when the body is unable to remove enough carbon dioxide through breathing. Other names for respiratory acidosis are hypercapnic acidosis and carbon dioxide acidosis. Causes of respiratory acidosis include: Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body. There are several types of metabolic acidosis: Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes . Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea. Lactic acidosis is a buildup of lactic acid . Lactic acid is mainly produced in muscle cells and red blood cells. It forms when the body breaks down carbohydrates to use for energy when oxygen levels are low. This can be caused by: Exercising vigorously for a very long time MELAS (a very rare genetic mitochondrial disorder that affects energy production) Prolonged lack of oxygen from shock, heart failure, or severe anemia Sepsis -- severe illness due to infection with bacteria or other germs Metabolic acidosis symptoms depend on the und Continue reading >>

Ketosis & Acidosis

Ketosis & Acidosis

Ketosis occurs when the fat in your body does not break down completely, producing ketones. It's a condition that can occur when you go on a low-carb diet and glycogen stores in your liver are depleted. When you have too much acid in your system, you can develop acidosis. The acid build-up can take place in your kidneys or lungs for a variety of reasons. The build-up of ketones can cause an imbalance that leads to excessive acid production. Video of the Day Diabetics may be prone to ketosis or acidosis when insulin levels drop below healthy levels or when ketones build up in the body due to uncontrolled insulin levels. Ketones are the byproduct produced when the body relies primarily on fat stores for energy. While short-term ketosis can help you lose weight, ketones that continue to build up in your blood and urine are poisonous and lead to diabetic ketoacidosis, also referred to as diabetic acidosis. The condition is a more common complication of Type 1 diabetes. In addition to low insulin levels, trauma, severe infection, a heart attack or surgery can lead to diabetic ketoacidosis. Diabetic acidosis requires immediate medical attention. As insulin levels drop, your body produces blood sugar by uncontrollably burning fat. Your body turns acidic as glucose begins to appear in your urine. As your body tries to find a balance, your breathing becomes deeper and quicker, leading to a temporary balance as you blow off excess carbon dioxide. Symptoms may start with confusion, thirst, fatigue and increased urination. You may become unconscious. As acidosis progresses, you can smell acetone on your breath. Symptoms usually appear quickly, so you should seek emergency treatment. A high fat and high protein diet that's low in carbohydrates can lead to ketosis. At the same time, Continue reading >>

Diagnosis And Treatment Of Diabetic Ketoacidosis (dka) In Dogs And Cats

Diagnosis And Treatment Of Diabetic Ketoacidosis (dka) In Dogs And Cats

What is DKA in Dogs and Cats? Diabetic Ketoacidosis (DKA) is a serious and life-threatening complication of diabetes mellitus that can occur in dogs and cats. DKA is characterized by hyperglycemia, ketonemia, +/- ketonuria, and metabolic acidosis. Ketone bodies are formed by lipolysis (breakdown) of fat and beta-oxidation when the metabolic demands of the cells are not met by the limited intracellular glucose concentrations. This provides alternative energy sources for cells, which are most important for the brain. The three ketones that are formed include beta-hydroxybutyrate, acetoacetate and acetone. Beta-hydroxybutyrate (BHB) and acetoacetate are anions of moderately strong acids contributing most to the academia (low blood pH). Acetone is the ketone body that can be detected on breath. In a normal animal, glucose enters the cell (with help of insulin) – undergoes glycolysis to pyruvate within cytosol – pyruvate moves into mitochondria (energy generating organelle in the cell) to enter the TCA cycle and ATP is formed. ATP is the main energy source of the body. When glucose cannot enter the cell, free fatty acids are broken down (lipolysis) and move into the cell to undergo beta-oxidation (creation of pyruvate). The pyruvate then moves into the mitochondria to enter the TCA cycle (by conversion to Acetyl-CoA first). However, when the TCA cycle is overwhelmed, the Acetyl-CoA is used in ketogenesis to form ketone bodies. Summary Diabetic Ketoacidosis (DKA) in Dogs and Cats When there is no insulin the body cannot utilize glucose and there is no intracellular glucose. The body then uses ketone bodes as an alternate source. When there is decreased insulin and increased counterregulatory hormones fatty acids are converted to AcCoA and then ketones. In the non-diabetic Continue reading >>

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