Acetoacetic acid is a beta-keto acid produced by the liver and kidneys from fatty acids. It can be used to produce energy for the heart and brain, but an overabundance of ketone bodies can lead to ketoacidosis, a life-threatening condition. Diabetes, glycogen storage disease, hyperthyroidism, and dietary disruptions can cause overproduction of acetoacetic acid.
Acetoacetic acid, or diacetic acid, is a naturally occurring keto acid, which is a type of molecule containing both ketone and carboxyl functional groups. This compound is a beta-keto acid, so called because the ketone group is located on the second carbon away from the acid group. Acetoacetic acid is formed by the liver and kidneys by metabolizing fatty acids. Along with other ketone bodies, this acid can be used to produce energy from the heart and brain, thus it has its biological importance.
Although acetoacetic acid is soluble in water, it is an unstable acid and decomposes into carbon dioxide and acetone after approximately 140 minutes. Under normal conditions, the brain and heart do not need acetoacetic acid for energy and very little will be produced. Individuals suffering from conditions such as diabetes or other conditions that impair metabolism can produce an overabundance of ketone bodies. Therefore, a doctor may administer a urine test using a chemical that changes color in the presence of acetoacetic acid, and the degree of color change can be assessed with the naked eye.
Detection of this acid, as well as other ketone bodies, is essential for diabetics. If a case of diabetes goes untreated, beta-keto acids can build up in the blood. Acetoacetic acid is a weak acid, but in sufficient concentrations it can cause the blood itself to become acidic. This condition is called ketoacidosis and, in its most extreme manifestations, can be life threatening. Small concentrations of ketone bodies in the blood are known as ketosis and are not always dangerous.
While diabetes is the best-known medical condition that can lead to overproduction of acetoacetic acid, other medical issues can also cause this process. Glycogen storage disease and conditions that increase metabolism, such as hyperthyroidism, can also create higher levels of beta-keto acids in the body. Perhaps the most frequent cause of this phenomenon are dietary disruptions, such as starvation, fasting, and anorexia.
When the body lacks food for a long time, the tissues begin to break down their reserves of fatty acids. The brain, however, lacks fatty acids to use and must instead rely on ketone body byproducts from other tissues. If the heart lacks fatty acids to use, it will eventually use ketone bodies as well. Therefore, this acid can be seen as a means of survival in extreme circumstances.
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