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Sample 

  1. Blood needed to prepare the serum.
  2. Urine ample may also be used.

Indications

  1. Ketone bodies are advised in patients with diabetes mellitus.
    1. Advise in case of uncontrolled diabetes mellitus.
    2. In ketoacidosis associated with alcoholism, starvation,  and high protein diet.

Definition

Pathophysiology

  1. Ketone bodies substrate is free fatty acids from the adipose.
  2. Long-chain fatty acids are taken up by the liver.
    1. In liver are reesterified to triglycerides and store in the liver.
    2. Or these are converted to very low-density lipoprotein and returns to blood.
  3. infants have earlier ketonuria than adult after decreased food intake.
  4. In uncontrolled diabetes mellitus:
    1. low insulin level leads to:
      1. increased lipolysis.
      2. Decreased reesterification.
      3. There are increased plasma free fatty acids.
      4. The insulin and glucagon ratio changes.
        1. This ratio is changed and enhances fatty acids oxidation
        2. It leads to increased ketone bodies formation in the liver and decreased peripheral tissue metabolism give rise to accumulation in the blood.
        3. There is an accumulation of acetoacetate ketone body in the blood.

 

Signs and Symptoms:

There may be :

  1. A cough.
  2. Fever.
  3. Chills.
  4. Chest pain.
  5. Arthralgia. 
  6. Dyspnoea.
  7. Tachycardia.
  8. Hypotension.
  9. Hypothermia.

Causes of ketone bodies formation:

  1. Starvation.
  2. Frequent vomiting.
  3. Diabetes mellitus.
  4. Glycogen storage disease (von Gierke disease).
  5. During pregnancy.

Lab findings are:

  1. Glucose level may range from 300 to 500 mg/dL.
  2. Ketones bodies are beta-hydroxybutyric acid, acetoacetic acid, and acetone is positive.
    • These are produced during gluconeogenesis, mainly due to increased fatty acid oxidation to acetyl CoA.
    • Excessive concentration of ketone bodies in the blood is called ketonemia.
    • When there is increased excretion in the urine is called ketonuria.
  3. Electrolytes show :
    1. Decreased Sodium. 
    2. Increased Potassium.
    3. Anion gap is increased.
    4. Total CO 2 decreased.
  4. Blood gases  shows:
    1. pH decreased.
    2. Metabolic acidosis.
    3. Bicarbonates are decreased.

Ketoacidosis and Diabetic ketosis:

Test Lab findings
Glucose 300 to 500 mg/dL
Ketones Positive (Acetone, Beta-hydroxybutyric acid and acetoacetic acid)
Electrolytes Sodium Decreased
  Potassium increased
  Total CO 2 decreased
  Anion gap increased
Blood gases pH decreased
  Bicarbonate decreased

                                                

Method to detect ketone bodies

  1. Sodium nitroprusside reaction gives lavender color.
    1. This is very sensitive 10 times for acetoacetate than with acetone.
    2. It does not react with beta-hydroxybutyrate.

                         

  1. Gerhardt's ferric chloride test mainly measure acetoacetate ketone body.

Treatment

    1. Start with saline for volume replacement.
    2. Insulin infusion (but delay if serum potassium level is low <_3.3 meq/L).
    3. Potassium replacement when the serum level is <5.5 meq/L.
    4. Glucose drip (5% dextrose with 0.45% saline when the plasma glucose level is <250 mg/dL.
    5. Continue glucose and insulin until the anion gap is <12 meq/L.
    6. Try to find the causative agent

 


Possible References Used

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