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Ketoacidosis

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Title: Ketoacidosis  
Author: World Heritage Encyclopedia
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Subject: High anion gap metabolic acidosis, Diabetic ketoacidosis, Diabetes mellitus type 1, Ketone bodies, Anion gap
Collection: Acid–base Disturbances
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Ketoacidosis

Ketoacidosis
Classification and external resources
Specialty Endocrinology
DiseasesDB 29670
eMedicine med/102

Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and β-hydroxybutyrate.

Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal.[1]

Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis.

Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct byproduct of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover.[2] Ketosis may also smell, but the odor is usually more subtle due to lower concentrations of acetone.

Contents

  • Cause 1
  • See also 2
  • References 3
  • External links 4

Cause

Two common types are alcoholic and diabetic ketoacidosis.

In diabetic patients, ketoacidosis is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis.

In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate.[3] The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

See also

References

  1. ^ "Death after soup and water diet". BBC News. 27 July 2009. 
  2. ^ Diabetic ketoacidosis at medical dictionary of National Institutes of Health.
  3. ^ Krebs, H. A.; Freedland, R. A.; Hems, R.; Stubbs, Marion (1969-03-01). "Inhibition of hepatic gluconeogenesis by ethanol". Biochemical Journal 112 (1): 117–124.  

External links

  • The Merck Manual - Diabetic Ketoacidosis
  • Alcoholic Ketoacidosis
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