KETOACIDOSIS

Course overview

KETOACIDOSIS IS A METABOLIC STATE ASSOCIATED WITH PATHOLOGICALLY HIGH SERUM AND URINE CONCENTRATIONS OF KETONE BODIES. CLINICALLY RELEVANT FORMS OF KETOACIDOSES INCLUDE DIABETIC KETOACIDOSIS (DKA), ALCOHOLIC KETOACIDOSIS (AKA), AND STARVATION KETOACIDOSIS. DKA IS A POTENTIALLY LIFE-THREATENING COMPLICATION OF UNCONTROLLED DIABETES. IT TYPICALLY OCCURS IN THE SETTING OF HYPERGLYCEMIA AND INSULIN DEFICIENCY, WHICH CAUSES UNOPPOSED LIPOLYSIS AND OXIDATION OF FREE FATTY ACIDS AND THEREBY RESULTS IN KETONE BODY PRODUCTION AND A SUBSEQUENT INCREASED ANION GAP METABOLIC ACIDOSIS. ALCOHOLIC KETOACIDOSIS OCCURS IN PATIENTS WITH CHRONIC ALCOHOL ABUSE, LIVER DISEASE, AND ACUTE ALCOHOL INGESTION. STARVATION KETOACIDOSIS OCCURS AFTER THE BODY IS DEPRIVED OF GLUCOSE AS ITS PRIMARY SOURCE OF ENERGY FOR A PROLONGED TIME, CAUSING FATTY ACIDS TO REPLACE GLUCOSE AS THE MAJOR METABOLIC FUEL. THIS ACTIVITY ILLUSTRATES THE EVALUATION, TREATMENT, AND COMPLICATIONS OF KETOACIDOSIS AND THE IMPORTANCE OF AN INTERPROFESSIONAL TEAM APPROACH TO ITS MANAGEMENT.