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Starvation Ketoacidosis
Aka: Starvation Ketoacidosis, Starvation Ketosis, Fasting Ketoacidosis, Fasting Ketosis
- See Also
- Ketoacidosis
- Alcoholic Ketoacidosis
- Euglycemic Ketoacidosis
- Pathophysiology
- See Ketoacidosis
- Fasting or starvation results in an inadequate Glucose supply for metabolic need
- Similar to Alcoholic Ketoacidosis (also related to inadequate Glucose)
- Ketone Bodies from Triglyceride metabolism (acetyl-CoA via ketogenic pathway) in the absence of Glucose
- Mild Ketosis (1 mmol/L) results from a 12-14 hour fast
- Moderate Ketosis (8-10 mmol/L) peaks
- Gradually after 20-30 days of inadequate calories (or within 3 days of Fasting)
- Serum bicarbonate ultimately falls and levels off at 18 mEq/L
- Differential Diagnosis
- See Ketoacidosis
- Alcoholic Ketoacidosis
- Euglycemic Ketoacidosis
- Low-Carbohydrate Diet (<40-50 g/day)
- May results in mild Ketosis
- Labs: Ketone Detection
- See Ketoacidosis
- Serum Beta-Hydroxybutyrate
- Primary metabolite of Ketone Bodies in most Ketoacidosis (includes Diabetic Ketoacidosis, Alcoholic Ketoacidosis)
- Urine Ketones
- Nitroprusside reaction detects acetone and Acetoacetate, but not Serum Beta-Hydroxybutyrate
- May be near normal despite significant Ketoacidosis (due to Beta-Hydroxybutyrate)
- Positive in Isoproteronol Poisoning (primarily due to acetone)
- Labs: General Labs
- Metabolic Acidosis with Anion Gap
- Absent only in Isoproteronol Poisoning (since acetone is not a charged partical)
- Metabolic panel (chemistry panel)
- Serum Sodium
- Serum Potassium
- Serum Glucose
- Serum Creatinine
- Serum Calcium
- Serum Magnesium
- Serum Phosphorus
- Venous Blood Gas
- Serum Osmolal Gap
- Increased in Alcoholic Ketoacidosis and in toxic Alcohol ingestions (e.g. Methanol, ethylene gylcol, propyl Alcohol)
- Management
- Differentiate from Diabetic Ketoacidosis, Euglycemic Ketoacidosis (SGLT2 Inhibitors), Alcoholic Ketoacidosis
- Insulin is not typically indicated in Starvation Ketoacidosis and Alcoholic Ketoacidosis
- Dextrose in crystalloid (NS, LR)
- Dextrose is critical in clearing Ketone Bodies
- In Alcoholic Ketoacidosis, Thiamine 100 mg is given prior to dextrose
- Electrolytes
- Monitor and replace Serum Potassium, Serum Magnesium, Serum Phosphorus
- References
- Mehta and Emmett in Sterns and Traub (2019) UpToDate, Fasting Ketosis and Alcoholic Ketoacidosis, accessed 7/19/2019