What is ketoacidosis?

Ketoacidosis is a metabolic disorder that occurs mainly in people with diabetes mellitus (diabetic ketoacidosis). Ketoacidosis can manifest itself through various symptoms, ranging from so-called kiss-mouth breathing to coma. Learn here what ketoacidosis is exactly, how it develops and what options are available for the therapy.

What does ketoacidosis mean?

The word ketoacidosis is composed of the terms acidosis and ketosis.

Acidosis refers to an acidic metabolism of the body, the pH of the blood is in the acidic range (<7.35). The cause is the preponderance of acidic substances in the blood, such as carbon dioxide (CO 2 ) and hydrogen ions (H + ).

A ketosis is an excess of so-called ketone bodies in the blood. These are sugar substitutes that the body can produce itself and that have acidic properties.

Taken together, ketoacidosis therefore means that there are so many acidic ketone bodies in the blood that the pH value of the blood has dropped to the acidic level. Ketoacidosis, in contrast to the respiratory acidosis caused by respiratory problems, belongs to the metabolic acidosis (metabolic acidosis).

Why does ketoacidosis develop?

The ketone body forms the body in the liver as a substitute for sugar particles (carbohydrates), which the body needs as an energy source for all its functions. Normally, ketone bodies form as an intermediate of fat metabolism and are always found in small amounts in the blood.

However, if there is not enough sugar, fatty acids are increasingly degraded to ketone bodies and released into the blood. For example, a sugar deficiency typically exists in diabetes (diabetes mellitus), starvation, and alcoholism.

Actually, the production of a sugar alternative is a sensible measure of the body to provide us with the required energy despite sugar shortage. But the acidic properties of the ketone bodies cause problems.

Symptoms of ketoacidosis

Ketoacidosis complaints usually develop slowly and over days. Symptoms may include abdominal pain, vomiting and fever.

In the case of diabetic ketoacidosis, a feverish infection is often the cause. Those affected feel strong thirst with simultaneous frequent urination.

A typical feature of ketoacidosis is deep breathing, the so-called "kiss-mouth breathing", because the body tries to breathe off the acidic substances during an acidic metabolism. In addition, the breath can smell acetone and thus sweet and a little like foul fruit.

Furthermore, it comes to balancing streams of blood salts (electrolytes). If the electrolyte conditions become unbalanced, cardiac arrhythmias may occur, as well as impaired kidney function and water retention, which are particularly dangerous for the brain (brain edema). In the final stages of ketoacidosis there is a risk of shock and coma.

Coma in a ketoacidosis

A coma in the context of ketoacidosis is called "ketoacidotic coma" and is typically produced in people with diabetes mellitus type 1 (called "coma diabeticum"). In the case of type 1, there is complete insulin deficiency, in contrast to type 2 diabetes mellitus, which can still produce some insulin.

The hormone insulin transports the sugar molecules into the cells, where they are needed as energy sources. If no insulin is available, the sugar molecules remain in the blood (hyperglycemia) and are missing in the cells.
Kompensatorisch the ketone bodies are formed. The subsequent hyperacidity of the blood can lead to impaired consciousness from fainting to a coma.

Therapy of a ketoacidosis

The treatment of ketoacidosis depends on how far the disease has progressed. If the person is in a coma, there is an emergency and immediately intensive care measures in the hospital must be taken. Breathing and circulation must be secured and the internal organs protected against failure.

It is always important to have sufficient fluid intake, which is achieved via an intravenous access. If there is a pronounced acidosis and a very low pH of the blood, compensating substances can be given off which buffer the acidic metabolism in the blood. In order to balance the electrolyte balance, often a sodium or potassium substitution is needed.

In the case of diabetic ketoacidosis, insulin is added to transport the sugar molecules into the cells. Diabetics should be educated by their doctor about the risk of ketoacidosis and given recommendations for proper behavior at the first signs of metabolic imbalance.

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