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
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