Ketosis Disorders Ketone bodies are a normal metabolic energy source. Excessive unregulated production of ketones, often accompanied by an anion gap acidosis, is seen in several disease states: • Starvation ketosis - normal consequence of fatty acid (FA) metabolism. Tx: provide carbohydrates (IVF or PO): The pt will produce endogenous insulin normally. Treat other deficiencies (thiamine). Monitor for development of re-feeding syndrome. • Alcoholic ketoacidosis (AKA) — seen in chronic alcoholics, often can be treated with dextrose containing IVF & thiamine. Treat concomitant alcohol withdrawal. • Diabetic ketoacidosis (DKA) - caused by complete insulin deficiency, leading to marked anion gap acidosis (pH < 7.35) w/ elevated blood glucose. • Euglycemic DKA is a variant seen with SGLT inhibitors & pregnancy, where blood glucose (BG) is normal. • Hyperglycemic hyperosmolar state (HHS) - partial insulin deficiency, causing minimal ketosis but marked increase in BG & osmolality. Glucosuria causes massive volume loss. • DKA/HHS Overlap - features of both DKA & HHS and treated the same. Nick Mark MD @nickmmark #Ketosis #Disorders #ketones #differential #diagnosis #management #endocrinology
