Ketoacidosis is a dangerous condition caused by a drop in insulin and a rise in glucose levels, primarily affecting diabetics and alcoholics. It can be triggered by infection, missed insulin treatments, trauma, stress, or excessive alcohol consumption. Symptoms include nausea, vomiting, dehydration, and ketonuria. Proper insulin treatment and moderate alcohol consumption can prevent ketoacidosis. Treatment involves replacing fluids with an electrolyte solution and seeking medical attention.
Ketoacidosis is a condition that occurs when a patient experiences a significant drop in insulin and a concomitant rise in glucose levels, usually above 250 mg/dL. Essentially exclusive to diabetics and alcoholics, ketoacidosis, also known as diabetic acidosis, DKA, or simply acidosis, is responsible for approximately 4-9% of hospital visits by diabetic patients. Its onset may be triggered by an underlying infection, most often a urinary tract infection (UTI), missed insulin treatments, trauma, stress, and, in the case of alcoholics, excessive alcohol consumption associated with a starvation diet .
The human body produces a number of hormones to aid in proper digestion and storage of food energy. An imbalance of insulin and glucagon, which regulate blood glucose levels, is primarily responsible for ketoacidosis. In a healthy individual, insulin production in the pancreas is stimulated in response to high blood glucose levels, such as after a meal. Insulin encourages the body to convert glucose into glycogen chains and fatty acids which can be stored in body fat for later use. Conversely, in a healthy individual, glucagon production is stimulated in response to a blood glucose deficit.
The body responds to the presence of glucagons by promoting the oxidation of fatty acids. Through this process, energetic compounds are produced. Acetyl CoA, a byproduct of fatty acid oxidation, is converted into ketone groups (acetoacetate, acetone and beta-hydroxybutyrate), which are a source of energy.
Normally, ketone production does not reach dangerous levels. However, in diabetics and alcoholics, it may proceed deregulated due to a lack of insulin and an overabundance of glucagons, respectively, or the metabolism of alcohol itself. Due to the acidic nature of ketone groups and the overproduction of glucose due to excess ketones, ketoacidosis can be highly toxic.
The common symptoms of this condition can be explained using the pathogen model described above. During ketoacidosis, excess glucose in the blood eventually “spills over” into the urine as a metabolic attempt to prevent high glucose concentrations. However, in this way essential salts (potassium, sodium, etc.) and water are eliminated. This process, together with the subsequent concentration of blood and therefore a drop in pH (due to ketones), leads to nausea, vomiting, frequent urination, dehydration, decreased skin firmness, dry skin, decreased sweating and ketonuria (presence of ketones in the urine). If left untreated, ketoacidosis can even lead to coma and death.
Ketoacidosis is easily prevented if proper measures are taken. A diabetic patient should be diligent with insulin treatments and alcohol should only be consumed in reasonable quantities. Should a diabetic or alcoholic experience the symptoms described above, the best treatment approach would be to replace fluids with an electrolyte solution, such as Gatorade, and seek out a hospital or clinic where fluids can be given intravenously. If the situation requires the use of medications, insulin will be used for diabetics and sodium bicarbonate (to normalize serum pH) for alcoholics.
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