Ketoacidosis

Background

• Ketones are an organic compound which contain a carbonyl group, a C=O double bond.
  • The human body creates primarily beta-hydroxybuityric acid via catabolism of fatty acids in the liver
• Beta-hydroxybutyric acid is a potent intracellular energy source which can be fed directly into the citric acid cycle for production of ATP

Clinical Features

• Acidosis presents variably depending on the degree and origin of the acidosis
• Ketoacidosis is characterized by the clinical syndrome and/or lab findings of acidosis in the setting of an underlying etiology which involves excessive ketone production

Differential Diagnosis

• Diabetic ketoacidosis
• Alcoholic ketoacidosis
• Starvation ketoacidosis

Workup

• Obtain chemistries to determine electrolyte status, anion gap, and bicarbonate levels
• Obtain blood gas to evaluate blood pH to objectively characterize acidosis
• Beta-hydroxybutyrate levels may be obtained to specifically distinguish ketones against other possible causes of acidosis
• Further workup should be guided by specific differential diagnoses

Diagnosis, Management, and Disposition

• Ketoacidosis is generally not a standalone diagnosis; Consider the differentials listed above and evaluate for underlying etiology.
• Management and disposition are determined based on patient condition and the underlying etiology