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Ketones |
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Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat instead of
the sugar glucose for energy. The ketone bodies -- acetone, acetoacetate, and beta-hydroxybutyrate -- are toxic acidic
chemicals. They build up in the blood and then spill over into the urine. The body can also rid itself of acetone through
the lungs. This gives the breath a fruity odor. The presence of ketone bodies in the blood is termed "ketosis" and in
urine is called "ketonuria."
Ketonuria: A condition in which abnormally high amounts of ketone bodies (a byproduct of the breakdown of cells)
are present in the urine.
Ketonuria is a sign seen in diabetes mellitus that is out of control. Diabetics prone to ketonuria need to monitor their
urine for signs of ketone buildup that could lead to life-threatening symptoms unless promptly treated. Ketonuria can also
develop as a result of fasting, dieting, starvation and eating disorders.
Ketone Bodies: What They Are, How They Accumulate
In some people with diabetes mellitus, the pancreas releases insufficient amounts of insulin or no insulin at all. Consequently, glucose goes largely undelivered. In a desperate attempt to provide fuel, the body begins feeding on itself -- that is, it breaks down muscle and fat to burn as fuel. Ketone bodies are a byproduct of this process.
Ketone bodies consist chemically of three substances (beta-hydroxybutyric acid, acetoacetic acid, and acetone).
When ketone bodies are released, they enter the bloodstream, acidify the blood, and are eventually excreted mostly in urine. (One type of ketone body exits via the lungs.) Without treatment, glucose and ketone bodies may build to dangerous levels in the blood. Stress and illness can increase the risk of glucose and ketone buildup. When glucose and ketone bodies build to very high levels, the following conditions then exist:
- Hyperglycemia: too much sugar in the blood.
- Ketoacidosis: too many ketone bodies in the blood.
- Ketonuria: accumulation of ketone bodies in the urine. When ketone is excreted, sodium is excreted along with it.
Symptoms and Treatment
Symptoms of glucose and ketone-body overload include thirst, frequent urination, dehydration, nausea, vomiting, heavy breathing, dilation of the pupils and confusion resulting from the toxic effects of ketone bodies and acid accumulation on the brain. In addition, the symptoms may also include a breath odor resembling the smell of fruit. (One type of ketone body, acetone, is excreted through the lungs, causing the fruity smell.) This symptom-complex can progress to coma and death.
Treatment with insulin and intravenous fluids can restore normal levels of blood sugar and end ketoacidosis and ketonuria.
Prevention
Prevention of emergencies in diabetics prone to ketonuria requires close monitoring
of the levels of glucose in the blood and ketone bodies in the urine. Although ketone-body overload in the blood occurs
primarily in type 1 diabetics, it can also occur in type 2 diabetics. Therefore, it is commonly recommended that all
diabetics should closely monitor not only their glucose levels but also their ketone levels.
Home tests kits are available to check both glucose and ketone levels.
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