Nutritional Ketosis with Ketogenic Diets or Exogenous Ketones: Features, Convergence, and Divergence. The term ‘ketone bodies’ refers to three molecules, acetoacetate (AcAc), 3‐β‐hydroxybutyrate (3HB) and acetone (Figure 1). Harrison's Principles of Internal Medicine, Alcoholic ketoacidosis and lactic acidosis, Unrecognized adult salicylate intoxication, Blood lactate and ketone body concentrations in salicylate intoxication, Diabetes Mellitus: Problems in Management, Lipogenesis from ketone bodies in the perfused rat liver: effects of acetate and ethanol, Dependence on blood acetate concentration of the metabolic effects of ethanol in perfused rat liver, Metabolic acidosis in the alcoholic: a pathophysiologic approach, The effects of ethanol on the metabolic activities of the liver, Urine glucose analyses during continuous blood glucose monitoring, Diagnosis and classification of diabetes mellitus and the nondiabetic meliturias, The effect of intensive treatment of diabetes on the development and progression of long‐term complications in insulin‐dependent diabetes mellitus. Efficacy and safety of D,L-3-hydroxybutyrate (D,L-3-HB) treatment in multiple acyl-CoA dehydrogenase deficiency. Abnormally large quantities of ketone bodies are found in the blood of individuals who are experiencing diabetic ketoacidosis, alcoholic ketoacidosis, salicylate poisoning, and other rare conditions. Diabetes is the most common pathological cause of elevated blood ketones. The Precision XtraTM Advanced Diabetes Management Systems is a simple‐to‐use hand‐held device that is currently available as a tool for self‐monitoring of blood 3HB levels in the home. More particularly, suitable test means are of the type having a nitroprusside in combination with at least one inorganic salt of a metal selected from the group of magnesium and calcium. Review article: Ketoacidosis in the emergency department. Nutrition, Metabolism and Cardiovascular Diseases. Diabetic Ketoacidosis and Related Events With Sotagliflozin Added to Insulin in Adults With Type 1 Diabetes: A Pooled Analysis of the inTandem 1 and 2 Studies. In the recently published Diabetes in Early Pregnancy Study140, for example, first‐trimester serum 3HB elevations were not found to be associated with fetal malformations in the offspring of women with Type 1 diabetes, and were also not associated with an increase in the risk of pregnancy loss. The resulting mild hyperketonemia is not associated with ketonuria. For those who are already comfortable with SMBG, the new technology offers the opportunity to obtain additional information without having to resort to the time consuming and sometimes unpleasant task of urine testing for ketones. Of pregnancy and progeny, Morphological and physiological effects of beta‐hydroxybutyrate on rat embryos grown, Diabetic ketoacidosis and the hyperglycemic, hyperosmolar nonketotic state, Insulin therapy of diabetic ketoacidosis: physiologic versus pharmacologic doses of insulin and their routes of administration, Diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic coma. Ketolysis is the process by which ketone bodies are converted into energy that can be used to fuel various intracellular metabolic activities. Furthermore, ketone tests based on the nitroprusside reaction have been reported to give false‐positive results in the presence of drugs containing sulfhydryl groups such as the antihypertensive drug Captopril®, mesna, N‐acetylcysteine, dimercaprol and penicillamine112-116. Effects of Dietary Carbohydrate Content on Circulating Metabolic Fuel Availability in the Postprandial State. Lexikon der Medizinischen Laboratoriumsdiagnostik. Review of Non-Invasive Glucose Sensing Techniques: Optical, Electrical and Breath Acetone. Ketogenic diets and prolonged exercise are also associated with physiological ketosis. Wound Healing, Tissue Repair, and Regeneration in Diabetes. Physicians reserved venous blood glucose testing to manage acute metabolic complications and intercurrent illnesses, and to investigate new or worsening symptoms101-104. Proteomic Analysis of the Diverse metabolic reactions activated during 58-hr fasting are revealed by non-targeted metabolomic analysis of human blood. Fatty acid production in adipose tissue is stimulated by epinephrine and glucagon and inhibited by insulin. Calibration-free breath acetone sensor with interference correction based on wavelength modulation spectroscopy near 8.2 $$\upmu$$μm. Relationship between glucose and fatty acid metabolism and the formation of ketone bodies in the hepatocyte. Philadelphia: Lea & Febiger, 1994; 738–770. The activity of this enzyme is increased by starvation and a high‐fat diet, and it is decreased by insulin. Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar nonketotic state (HHNS) are two serious, acute metabolic complications of diabetes53, 54. However, it is the rate of production of ketones, not an impaired uptake, that appears to be the major factor in hyperketonemia34. Acetoacetic acid and acetone react with alkaline solution of sodium nitroprusside to form a purple colored complex. This process takes place in the mitochondria of perivenous hepatocytes20-23. As DKA improves with insulin therapy, there is an overall reduction in the levels of ketone bodies and a coincident conversion of 3HB to AcAc, which is driven by an increasingly oxidized state in the hepatocytes. Some commercial tests for ketone bodies contain glycine and hence can detect both acetone and AcAc, while others only detect AcAc. Some commercial tests for ketone bodies contain glycine and hence can detect both acetone and AcAc, while others only detect AcAc. An overwhelming majority of laboratories fail to follow procedures to eliminate or recognize these false‐positive results117, 118. Ketonuria in neonates is abnormal and suggestive of an inborn error of metabolism.

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