Legend: A: Muscle fiber, B: Amino acids, C: Liver, E: Fatty acids, F: Glucagon, G: Blood vessel Process: 1. Lack of insulin leads to the release of amino acids from the muscle fiber. 2. Amino acids are released from the muscle fiber, which get converted into glucose inside of the liver. 3. The glucose produced becomes abundant in the bloodstream. 4. Fatty acids and glycerol are released from the adipose tissue, which get converted into ketones inside of the liver. 5. Along with the fatty acids and glycerol, the glucose produced from the lack of insulin also gets converted into ketones inside of the liver. 6. The ketones produced become abundant in the bloodstream. This leads to high blood sugar levels, nausea, vomiting, thirst, excessive urine production, and abdominal pain.<unk>  is caused by the uncontrolled production of ketone bodies. Usually the production of ketones is carefully controlled by several hormones, most importantly insulin. If the mechanisms that control ketone production fail, ketone levels may become dramatically elevated and cause dangerous changes in physiology such as a metabolic acidosis. Diabetes The most common cause of<unk>  is a deficiency of insulin in type 1 diabetes or late-stage type 2 diabetes. This is called diabetic<unk>  and is characterized by hyperglycemia, dehydration and metabolic acidosis. Other electrolyte disturbances such as hyperkalemia and hyponatremia may also be present. A lack of insulin in the bloodstream allows unregulated fatty acid release from adipose tissue which increases fatty acid oxidation to acetyl CoA, some of which is diverted to ketogenesis. This raises ketone levels significantly above what is seen in normal physiology. Alcohol Alcoholic<unk>  is caused by complex physiology that is usually the result of prolonged and heavy alcohol intake in the setting of poor nutrition. Chronic alcohol use can cause depleted hepatic glycogen stores and ethanol metabolism further impairs gluconeogenesis. This can reduce glucose availability and lead to hypoglycemia and increased reliance on fatty acid and ketone metabolism. An additional stressor such as vomiting or dehydration can cause an increase in counterregulatory hormones such as glucagon, cortisol and growth hormone which may further increase free fatty acid release and ketone production. Ethanol metabolism can also increase blood lactic acid levels which may also contribute to a metabolic acidosis. Starvation Starvation is a rare cause of<unk> , usually instead causing physiologic ketosis without<unk> .<unk>  from starvation, most commonly occurs in the setting of an additional metabolic stressor such as pregnancy, lactation, or acute illness. Medications Certain medications can also cause elevated ketones such as SGLT2 inhibitors causing euglycemic<unk> . Overdose of salicylates or isoniazid can also cause<unk> . Toxins<unk>  can be the result of ingestion of methanol, ethylene glycol, isopropyl alcohol, and acetone.
Ketoacidosis
Ketosis
Acidosis
Alkalosis
Organic acidemia
Hyperammonemia
Algaemia
Lactic acidosis