Ketoacidosis

 Lipidosis are the disorders which result due to lipid accumulation. Some enzyme abnormalities prevent the conversion of body fats into energy; this is termed fatty acid oxidation disorders.

Ketoacidosis

Ketone bodies are produced when the body burns fat for energy. If insulin secretion is decreased in the body, ketone bodies will begin to build-up in the bloodstream and will result in a life-threatening condition known as ketoacidosis. 

Types Along with general ketoacidosis, there are some specific types like: 

1) Alcoholic ketoacidosis, caused by excessive alcohol consumption. 

2) Diabetic ketoacidosis (Dka), occurring due to type 1diabetes. 

3) Starvation ketoacidosis, commonly seen in pregnant women, in their third trimester, and experiencing (occuring) excessive vomiting.

 These situations raise the acid level in the system and sometimes reduce the insulin production in the body. It results in the breakdown of fat cells to generate ketones. 

Causes 

1) Alcoholic Ketoacidosis: It occurs due to more intake of alcohol for a prolonged time. Excessive alcohol consumption causes malnourishment (fewer nutrients available in the body to function properly). Excessive drinking may also result in vomiting, thus, not eating enough nutrients, and excessive vomiting for a long period results in starvation, which further reduces insulin production in the body. A malnourished alcoholic person may develop alcoholic ketoacidosis. 

2) Diabetic Ketoacidosis 

i) Other infections and diseased conditions (like pneumonia and urinary tract infections) release higher concentration of certain hormones like adrenaline or cortisol. These hormones counteract insulin and thus trigger an episode of diabetic ketoacidosis, 

ii) Due to missed insulin treatments or inadequate insulin therapy, the insulin level of body decreases accidentally, causing diabetic ketoacidosis, 

iii) Trauma (either physical or emotional), 

iv) Cardiac arrest. 

v) Alcohol or drug abuse (like cocaine), and 

Vi) Medications like corticosteroids and some diuretics.

Symptoms

1) Alcoholic Ketoacidosis: 

Symptoms of alcoholic ketoacidosis are: 

i) Pain in the abdomen, 

ii) Confusion and agitation, 

iii) Reduced alertness or coma, 

iv) Fatigue, 

v) Slowed movement, 

vi) Irregular, deep, and fast breathing (Kussmaul's sign), 

vii) Loss of appetite, 

viii) Nausea and vomiting, and 

ix) Dehydration-like symptoms, e.g. dizziness (vertigo), lightheadedness, and thirst. 

2). Diabetic Ketoacidosis: Ketones build-up in blood and urine, causing the following symptoms: 

i) Abdominal pain (common in children). 

ii) Confusion, 

iii) Less perspiration, 

iv) Deep and rapid breathing (a later symptom). 

v) Dry and cooler skin, 

vi) Elevated thirst and urination, 

vii) Fatigue, 

viii) Increased blood glucose level, 

ix) Nausea and vomiting,

x) Ketones detected in the urine, 

xi) Weight loss, and 

xii) Sweet, fruity odour in breath (like nail polish remover) 

Diagnosis 

1) Alcoholic Ketoacidosis: It may be diagnosed by the following tests: 

i) Amylase and Lipase Tests: These tests monitor the functioning of pancreas and diagnose pancreatitis. 

ii) Arterial Blood Gas Tests: These tests measure levels of blood's oxygen and acid/base balance. 

iii) Anion Gap Calculation: This measures sodium and potassium levels. 

iv)- Blood Alcohol Tests: These tests measure concentration of alcohol dissolved in the blood. 

v) ,Blood Chemistry Panel: This involves comprehensive study of body metabolism and functioning. 

vi Blood Glucose Tests: These tests measure concentration of glucose in blood. 

vii) Blood Urea Nitrogen and Creatinine Tests: These tests determine kidney functioning.

viii) Serum Lactate Tests: These tests determine lactate levels in the blood. Lactic acidosis causes high lactate levels. This is a condition where body cells and tissues are not receiving enough oxygen. 

ix). Urine Tests: These tests detect the presence of ketones. 

2) Diabetic Ketoacidosis: Laboratory tests like, blood and urine tests are performed to diagnose diabetic ketoacidosis. Home use kits for tests for ketones are also available.

 Treatment 

1) Alcoholic Ketoacidosis: Signs like heart rate, blood pressure, and breathing are monitored. Intravenous fluids are administered. Vitamins and following nutrients are given immediately to treat malnutrition: 

i) Thiamine,  ii) Phosphorus,

iii) Potassium,  iv) Magnesium. 

2) Diabetic Ketoacidosis: 

Treatment of ketoacidosis focuses on the following: 

i) Resuscitation of fluids, ii) Acidosis and ketosis reversal, 

iii) Lowering plasma glucose concentration to normal, 

iv) Electrolyte replenishment along with the volume losses, and v) Identifying the causes.

Following medications are prescribed by the physician for management of diabetic ketoacidosis: 

i) Rapid-acting insulin (e.g., insulin aspartate), 

ii) Short-acting insulin (e.g., regular insulin), 

iii) Electrolyte supplements (e.g., potassium chloride), 

iv) Alkalinising agents (e.g., sodium bicarbonate).