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



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