Ketoacidosis is a serious metabolic condition characterised by an accumulation of ketone bodies in the blood, leading to a decrease in blood pH (acidosis).
It occurs when the body starts breaking down fats at an excessive rate, producing ketones faster than they can be utilised or cleared.
Types of ketoacidosis
There are 3 types of ketoacidosis:
- diabetic ketoacidosis
- alcoholic ketoacidosis
- starvation ketoacidosis
Diabetic ketoacidosis
This is a complication of diabetes, particularly type 1 diabetes, but can also occur in type 2 diabetes. It happens when insulin levels are too low, leading to high blood glucose levels and subsequent ketone production. Common causes include infection, stress, missed insulin doses or undiagnosed diabetes.
Symptoms can include:
- High blood sugar levels
- Ketones in the urine
- Fruity-smelling breath
- Rapid breathing
- Nausea and vomiting
- Abdominal pain
- Confusion or lethargy
Alcoholic ketoacidosis
This can occur in people with chronic alcohol consumption. It is more prevalent in people who have been drinking heavily and then suddenly reduce their intake or stop drinking.
Symptoms can include:
- Abdominal pain
- Nausea and vomiting
- Confusion
- Dehydration
- Rapid breathing
Starvation ketoacidosis
Starvation ketoacidosis is a type of ketoacidosis that occurs in the context of prolonged fasting, starvation, or extreme caloric restriction. It results from the body’s response to inadequate glucose availability, which leads to increased fat metabolism and elevated ketone production. Some extreme diets which recommend calorie restriction can easily cause ketoacidosis.
When the body is deprived of carbohydrates for an extended period, it shifts from using glucose as its primary energy source to using fatty acids. As fats are broken down, ketone bodies are produced as an alternative energy source. In cases of prolonged starvation or very low carbohydrate intake, ketone production can become excessive, leading to ketoacidosis.
Symptoms can include:
- Fatigue and weakness
- Nausea and vomiting
- Abdominal pain
- Dehydration
- Confusion or irritability
- Fruity-smelling breath (similar to diabetic ketoacidosis)
Ketoacidosis treatment
Treatment for ketoacidosis typically involves:
- addressing the underlying cause
- administering fluids
- electrolytes
- insulin
- providing supportive care
- reintroducing carbohydrates and adequate nutrition
It’s important to seek medical attention if ketoacidosis is suspected, as it can lead to serious complications if not treated promptly.
References
- Adult diabetic ketoacidosis. National Institutes of Health, USA. Accessed 18 July 2024
- Alcohol ketoacidosis. National Institutes of Health, USA. Accessed 18 July 2024
- Ketoacidosis. National Institutes of Health, USA. Accessed 18 July 2024
- Starvation ketoacidosis on the acute medical take. National Institutes of Health, USA. Accessed 18 July 2024
Last reviewed and updated: 18 July 2024