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Fasting ketosis and alcoholic ketoacidosis

Ankit Mehta, MD
Michael Emmett, MD
Section Editors
Richard H Sterns, MD
Stephen J Traub, MD
Deputy Editor
John P Forman, MD, MSc


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".)


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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Literature review current through: Nov 2017. | This topic last updated: Nov 01, 2016.
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