Fasting ketosis and alcoholic ketoacidosis
- Ankit Mehta, MD
Ankit Mehta, MD
- Assistant Professor, Department of Internal Medicine, Texas A&M College of Medicine, Dallas
- Associate Program Director, Internal Medicine Residency, Baylor University Medical Center, Dallas
- Michael Emmett, MD
Michael Emmett, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Chief of Internal Medicine
- Baylor University Medical Center
- Section Editors
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
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.
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- PHYSIOLOGY OF KETONE BODIES
- FASTING KETOSIS
- Fasting ketoacidosis
- ALCOHOLIC KETOACIDOSIS
- Clinical presentation
- Laboratory findings
- - Hypoglycemia or hyperglycemia
- - Potassium depletion and hypokalemia
- - Phosphate depletion and hypophosphatemia
- - Magnesium depletion and hypomagnesemia
- - Elevated serum osmolal gap
- - Combined acid-base disorders
- Detection of ketone bodies
- - Nitroprusside testing
- False-negative nitroprusside testing
- False-positive nitroprusside testing
- - Direct measurement of serum beta-hydroxybutyrate
- Differential diagnosis
- Thiamine before dextrose in alcoholic patients
- Dextrose and saline solutions
- Potassium administration
- Phosphate administration
- Magnesium administration
- SUMMARY AND RECOMMENDATIONS