How is ketone body clearance decreased in alcoholic ketoacidosis (AKA)?

Updated: Aug 27, 2020
  • Author: George Ansstas, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Increased availability of free fatty acids, which provide the major substrate for ketone body formation. Low insulin levels and elevated glucagon, catecholamine, growth hormone, and cortisol levels provide a hormonal milieu that inhibits the hepatic metabolism of acetyl-coenzyme A via the citric acid cycle and triglyceride synthesis, resulting in ketogenesis. In AKA, the increased ratio of NADH/NAD+ increases the proportion of beta hydroxybutyrate relative to acetoacetate. [5, 12]

Ketone body clearance is decreased by 2 major mechanisms, as follows:

  • The low insulin level characteristic of AKA prevents ketone body utilization by insulin-sensitive tissues

  • Dehydration impairs the excretion of ketones by the kidneys

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