This is known as starvation ketoacidosis. Here, we present the case of a 38-year-old female with anorexia nervosa who was diagnosed with starvation ketoacidosis. Poor dietary intake, prolonged fasting, malnutrition, alcoholism, and protein-based diets may induce ketoacidosis without diabetes mellitus.
Can starvation cause ketones in urine?
Not eating enough food can also sometimes trigger diabetic ketoacidosis. The symptoms of diabetic ketoacidosis include: high blood glucose levels. rising levels of ketones in the urine.
Do ketone levels increase during starvation?
Higher levels of circulating ketone bodies do not occur during starvation because fasting blood insulin levels remain in the low normal range which is sufficient to prevent an unrestricted increase of lipolysis.
What causes false positive ketones in urine?
Drugs containing free-sulfhydryl groups such as captopril (an antihypertensive drug) and D-penicillamine (an antibiotic) can produce false-positive ketone results on the reagent strip. Highly pigmented urine can also produce a false-positive result.
Why would ketones be high in urine?
Having some ketones in your urine is normal. But high ketone levels in urine may be a sign that your body is too acidic. This condition is called ketoacidosis. The most common type of ketoacidosis is a complication of diabetes called diabetic ketoacidosis (DKA).
Why ketone bodies are present in starvation?
Fatty acids themselves are not metabolized by the brain, so that ketone bodies (which do cross the blood-brain barrier) are the fuel of choice during starvation.
How are starvation ketones treated?
In summary, in starvation ketoacidosis the safest approach to treatment may be to start providing carbohydrate whilst also considering the patient’s risk of other deficiencies and treating accordingly. In cases of treatment failure or hyperglycaemia, IV insulin can be added.
Why are ketone bodies crucial during starvation?
By using ketone bodies, the brain needs less glucose. This is vital for survival, as glucose in starvation is derived from muscle amino acids, and losing one-third of body protein will result in death. As the brain uses more ketone bodies for energy, less proteolysis is necessary.
Does malnutrition cause ketoacidosis?
Malnutrition and poor dietary intake are ways to enter a state of starvation that may result in ketoacidosis . Gastric banding has also been associated with a risk of starvation ketoacidosis .
Can anorexia cause metabolic acidosis?
The onset of a metabolic acidosis in a patient with anorexia nervosa remains very rare, but also exceptionally severe and unknown to physicians. To our knowledge, this is the first reported case of starvation-induced metabolic acidosis in a non-diabetic adolescent with anorexia nervosa.
Can dehydration cause trace ketones in urine?
Drinking more water can help with ketone levels because dehydration can cause your body to create ketones.
What should I do if I have ketones in my urine?
Talk to your doctor immediately if your urine results show moderate or large amounts of ketones. This is a sign that your diabetes is out of control, or that you are getting sick. If you are unable to reach your diabetes care team, head for the emergency room or an urgent care facility.
Can ketones be high with normal blood sugar?
5 – Can you get ketones with a normal or low blood sugar? Ketones can also be present when your blood sugar is normal or low.
Is 1+ ketones in urine normal?
Less than 0.6 = normal. 0.6 – 1.0 = slightly high. 1.0 – 3.0 = moderately high. Higher than 3.0 = very high.
What diseases cause ketones in the urine?
- Poorly controlled diabetes.
- Diabetic ketoacidosis (DKA).
- Starvation: not eating for prolonged periods (for example, 12 to 18 hours).
- Anorexia nervosa.
- Bulimia nervosa.
- Alcohol dependency.
- Ketogenic diet (high-fat, low-carbohydrate diet).
What infections cause ketones in urine?
Additionally, there may be signs of illnesses such as sepsis, pneumonia, and urinary tract infections that can lead to high ketone levels.
What level of ketones is too high?
1.6 to 2.9mmol/L means you’re at an increased risk of DKA and should contact your diabetes team or GP as soon as possible. 3mmol/L or above means you have a very high risk of DKA and should get medical help immediately.
What are the signs of starvation?
- reduced appetite.
- lack of interest in food and drink.
- feeling tired all the time.
- feeling weaker.
- getting ill often and taking a long time to recover.
- wounds taking a long time to heal.
- poor concentration.
- feeling cold most of the time.
What does starvation do to the kidneys?
During starvation two characteristic changes in kidney function occur: a reduction in glomerular filtration rate by about 50% and a decrease in renal uric acid clearance by impairment of tubular uric acid secretion with consequent hyperuricaemia.
How can you tell the difference between diabetic ketoacidosis and starvation?
In a manner very similar to diabetic ketoacidosis, a lack of insulin is to blame in the case of prolonged starvation; however the difference is that the mechanisms of insulin secretion are intact, and some low baseline insulin level remains.
What causes ketones in urine if not diabetic?
People without diabetes can also have ketones in the urine if their body is using fat for fuel instead of glucose. This can happen with chronic vomiting, extreme exercise, low-carbohydrate diets (ketogenic or keto diets), or eating disorders.
What can mimic diabetic ketoacidosis?
DKA can easily be misdiagnosed because clinical features usually mimic infectious diseases [2-4], surgical emergencies such as acute abdomen, bowel perforation, appendicitis and ruptured ectopic pregnancy [6-8].
Can non diabetics get ketoacidosis?
Non-diabetic ketoacidosis is a rare condition which can be caused by starvation. Lack of glucose can force the body into ketogenesis causing a metabolic acidosis. As previously reported in the literature, ketoacidosis might, on rare occasions, be caused by a diet with low carbohydrate content.
Do ketones damage kidneys?
Ketosis Effects on the Kidneys Very high levels of ketones make your blood more acidic and overburden your kidneys. “Medical News Today” reports that one of the side effects of a ketogenic diet is the formation of kidney stones.
What increases ketones in the body?
Ketones are always present in the blood and their levels increase during fasting and prolonged exercise. They are also found in the blood of neonates and pregnant women. Diabetes is the most common pathological cause of elevated blood ketones.