Ketoacidosis

Ketogenesis is the process of producing ketone bodies, which are water-soluble molecules used as an alternative energy source.

In absence of insulin, ketogenesis is accelerated leading to accumulation of ketone bodies and ketoacidosis. This occurs due to either:

DKA is covered in detail under Diabetic Ketoacidosis.

Ketone bodies are the organic acids:

• Acetoacetate
  Detected by urine dipstick.
• β-hydroxybutyrate
  Detected by finger-prick ketones.

• DKA
  Pathological absence of insulin.
  • ↑ BSL
  • Severe acidosis
  • β-hydroxybutyrate predominates
• Starvation ketosis
  Generally >3 day starvation which depletes hepatic glycogen stores, causing ↓ BSL and ↓ insulin secretion.
  • ↓ BSL
  • Generally only mild ketosis and acidosis
    May have a normal AG.
  • Risk of refeeding syndrome when intake resumes
• Alcoholic ketoacidosis
  ↓ Carbohydrate intake with alcohol binge causing ↓ insulin secretion
  • ↓ BSL
  • Moderate acidosis
  • β-hydroxybutyrate predominates
    Ethanol metabolism has depleted NAD⁺, which drives metabolism of acetoacetate to β-hydroxybutyrate.

Refeeding syndrome is covered in Refeeding Syndrome.

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References

1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.