Diabetic keto-acidosis

Hayakawa M, Gando S, Morimoto Y, Kemmotsu O. Development of severe diabetic keto-acidosis with shock after changing interferon-beta into interferon-alpha for chronic hepatitis C. Intensive Care Med 2000 26(7) 1008. 

Land JM, A Court CH, Gillmer MD, Ledingham JG. Severe non-diabetic keto-acidosis causing intrauterine death. Br J Obstet Gynaecol 1992 99(l) 77-9. 

Systemic disease processes such as gastrointestinal disorders and diabetic keto-acidosis (acetone) manifest themselves in odors associated with breath and/or saliva The classic... 

Long chain acyl-CoA esters cause a competitive inhibition of acetyl-CoA-carboxylase. The elevated levels of long chain fatty acid Co-A esters in diabetes and on starvation may be the basis of the keto-acidosis (Bobtz et al. 1963). Citrate synthase (condensing enzyme) is also inhibited by long chaiii acyl-CoA esters (Wieland et al. 1963 a, b). It appears therefore that the product of fatty acid synthesis is able to regulate the synthesis by means of a feed back mechanism. 

This chapter describes the case reports of these enzyme deficiencies and the underlying biochemistry of the disorders and their associations. It is not the intention to discuss keto acidosis associated with other diseases, for example juvenile diabetes, or ketogenesis and its control which are reviewed elsewhere (Wildenhoff, 1975, 1977 McGarry and Foster, 1976 Halperin, 1977). In addition to the common occurrence of 3-hydroxybutyrate and acetoacetate in body fluids of patients with keto acidosis, secondary organic acids have been observed in urine, including adipic and suberic acids (Pettersen et aL, 1972), 3-hydroxyisovaleric acid (Landaas, 1974), 3-hydroxyisobutyric acid and 2-methyl-3-hydroxybutyric acid (Landaas, 1975). The dicarboxylic acids occur as a result of initial co-oxidation of accumulating long-chain fatty acids followed by )8-oxidation (Pettersen, 1972), and metabolites of the branched-chain amino acids occur because of inhibition of their metabolic pathways by 3-hydroxybutyrate and acetoacetate (Landaas and Jakobs, 1977). 

This condition is called ketosis or acidosis. The acidosis, a decrease in pH of the blood, results from the elimination of the two acids in the urine as the ammonium or sodium salts. Ketosis and acidosis occur in diabetes, liver disease, starvation, alcoholism, and ingestion of a keto-genic diet (with large fat-carbohydrate ratio). 

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