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Ketone Levels in Blood: Understanding, Causes, and When to Request Medical Aid

Ketone Levels in the Blood: Understanding, Triggers, and When to Get Medical Attention

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High Levels of Ketones: Understanding, triggers, and reasons for medical attention
High Levels of Ketones: Understanding, triggers, and reasons for medical attention

Ketone Levels in Blood: Understanding, Causes, and When to Request Medical Aid

Ketoacidosis, specifically diabetic ketoacidosis (DKA), is a serious metabolic condition that arises from a severe deficiency of insulin in the body. This deficiency prevents glucose from entering cells to be used for energy, leading the body to burn fat instead, producing high levels of acidic ketones that accumulate in the blood[1][5].

Causes

Ketoacidosis can be triggered by several factors, including:

  • Insulin deficiency due to missed insulin doses, incorrect dosing, or malfunction of insulin pumps (clogs, kinks, disconnections)[1][5].
  • Infections and illnesses such as pneumonia or urinary tract infections, which increase stress hormones (adrenaline, cortisol) that counteract insulin's effects[1][5].
  • Physical or emotional stress, including surgery, heart attack, stroke, or trauma[1][5].
  • Decreased food and water intake, alcohol or drug misuse, pregnancy, and certain medications like corticosteroids and diuretics[1][5].

Symptoms

Early symptoms of ketoacidosis may include excessive thirst, dry mouth, frequent urination, dehydration, fatigue, and weakness[1][2]. As DKA progresses, symptoms can become more severe, including shortness of breath, headache, fruity-smelling breath, dry or flushed skin, confusion, difficulty paying attention, muscle aches or stiffness, nausea, vomiting, and stomach pain[1][5]. High blood glucose levels (typically above 250-300 mg/dL) and serum ketones levels (greater than 1.0 mmol/L) indicate ketoacidosis[1][2].

Treatment

Early recognition and treatment of ketoacidosis are critical to prevent life-threatening complications affecting organs such as the heart, kidneys, and brain[3]. Treatment involves:

  1. Immediate intravenous fluids to rehydrate and dilute the ketones[1][3].
  2. Insulin therapy to decrease blood glucose and stop ketone production[1][3][5].
  3. Frequent monitoring of blood glucose, ketones, electrolytes, and acid-base balance through blood tests[3][4].
  4. Identification and treatment of underlying causes such as infections or other stressors[3].
  5. Correction of electrolyte imbalances, especially potassium, which may drop dangerously low due to treatment and affect heart function[5].

For people with diabetes, regular testing of ketones may be necessary if they have high blood sugar or are feeling particularly unwell. People with gestational diabetes may also experience ketoacidosis due to high amounts of glucose and low amounts of insulin in their blood.

Ketonemia, or an unusually high amount of ketones in the blood, is not harmful in itself but can lead to ketoacidosis if left untreated. Mild starvation ketosis can occur after fasting for a long time.

In contrast, ketosis, a state where the body burns fat for energy, is a normal process that can occur during a ketogenic (keto) diet, which requires low carbohydrate and moderate protein intake. However, this type of ketosis is generally not harmful and does not lead to ketoacidosis unless there is a severe insulin deficiency.

People with alcohol use disorder may experience ketonemia due to heavy alcohol use, low blood sugar, and the effects of heavy alcohol use such as nausea and vomiting.

For those wanting to measure their blood ketone levels at home, blood ketone meters are available. It is essential to consult a doctor for proper guidance and interpretation of the results.

[1] Mayo Clinic. (2021). Diabetic ketoacidosis (DKA). [online] Available at: https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20365743

[2] American Diabetes Association. (2019). Classification and diagnosis of diabetes: Standards of medical care in diabetes—2019. Diabetes Care, 42(Supplement 1), S13-S27. doi: 10.2337/dc19-S013

[3] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Diabetic ketoacidosis. [online] Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/dka-dmi

[4] American Association of Clinical Endocrinologists. (2018). Medical management of diabetic ketoacidosis. Endocrine Practice, 24(4), 461-477. doi: 10.1530/EP-18-0075

[5] American Diabetes Association. (2019). Diabetes emergency care: Recognition and management of diabetic ketoacidosis and hyperglycemic hyperosmolar state. Diabetes Care, 42(Supplement 1), S118-S126. doi: 10.2337/dc19-S0118

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