Ketoacidosis is a metabolic state associated with a high concentration of ketone bodies, formed by the breakdown of fatty acids and deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and -hydroxybutyrate.
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The three common causes of ketoacidosis are alcohol, starvation, and diabetes, which results in alcohol ketoacidosis, hunger ketoacidosis, and diabetic ketoacidosis respectively.
In diabetic ketoacidosis, high ketone body concentrations are usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in people with type 1 diabetes a lack of insulin in the bloodstream prevents glucose uptake, thereby inhibiting the production of oxaloacetate by decreasing pyruvate levels, and may result in the production of unexamined ketone bodies (through the metabolism of fatty acids) potentially causing harmful levels of glucose and ketones in the blood. Hyperglycemia causes glucose to burden the kidneys and spill into the urine (maximum transport for glucose is exceeded). The result of dehydration follows the osmotic motion of water into urine (osmotic diuresis), aggravating acidosis.
In alcoholic ketoacidosis, alcohol causes dehydration and inhibits the first step of gluconeogenesis by depleting oxaloacetate. The body can not synthesize enough glucose to meet its needs, thus creating an energy crisis that results in the metabolism of fatty acids, and the formation of ketone bodies.
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Mechanism
Ketoacidosis is a pathological metabolic state characterized by an extreme and uncontrolled ketosis. In ketoacidosis, the body fails to regulate the production of ketones inadequately resulting in a very severe accumulation of keto acids that decreases the pH of the blood substantially. In extreme cases, ketoacidosis can be fatal.
Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fats and proteins in response to respiratory substrate needs. Prolonged alcoholism can lead to alcoholic ketoacidosis. Ketoacidosis can be smelled by one's breath. This is caused by acetone, a direct byproduct of the spontaneous decomposition of acetoacetic acid. Often described as smelling like a fruit or a nail polish remover. Ketosis can also odor, but the smell is usually smoother due to lower concentrations of acetone.
Management
Treatment consists only of improving blood sugar and insulin levels, which will stop the production of ketones. If case severity requires more aggressive action, intravenous sodium bicarbonate infusions may be given to increase blood pH back to an acceptable range. However, serious attention should be made to sodium bicarbonate IV to avoid the risk of life-threatening hypernatremia.
See also
- Ketoacidosis alcohol
- Diabetic ketoacidosis
- Keto Acid
- Kussmaul breathe
References
External links
Source of the article : Wikipedia
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