Ver el código de «Starvation ketoacidosis»

==Background==
*Etiology: prolonged fasting, eating disorders, severely calorie-restricted diets, restricted access to food
*Low insulin/high glucagon in fasting state leads to increased lipolysis. Fatty acids initially converted to acety-CoA, which is then oxidized by the Kreb cycle. 
*When Kreb's cycle oversaturated by excessive adipose breakdown, acetyl-CoA enters ketogenic pathway, resulting in ketone body production
*Mild ketosis (1mmol/L) occurs  after fasting for ~12 to 14 hours. 
*Ketoacidosis rises with continued fasting, peaks after 20 to 30 days (8-10mmol/L). 

==Clinical Features==
*[[Nausea/vomiting]]
*[[Abdominal pain]]
*[[Dehydration]]
*[[Altered mental status]]
*Fatigue
*[[Tachypnea]], Kussmaul breathing

==Differential Diagnosis==
*[[Diabetic ketoacidosis]]
*[[Alcoholic ketoacidosis]]
*[[Lactic acidosis]]
*[[Toxic alcohols]] (methanol or ethylene glycol) ingestion
*[[Uremia]]
*[[Salicylate toxicity]]
*[[Sepsis]]

==Evaluation==
*Serum chemistry (elevated anion gap)
*VBG
*Glucose (usually euglycemic or hypoglycemic)
*[[Urinalysis]] (ketonuria)
*Serum beta-hydroxybutyrate
*Lactate
*Salicylate level (if overdose suspected)
*Serum osmolality (if toxic alcohol ingestion suspected)

==Management==
*[[Dextrose]]
**Resultant increased insulin/decreased glucagon secretion to halt ketone production and facilitate ketone metabolism 
**Correct hypokalemia PRIOR to glucose administration (insulin stimulated by dextrose will drive K+ into cells and worsen hypokalemia)
*Volume resuscitation with [[Normal saline]] or lactated ringers
*Correct any concomitant [[electrolyte abnormalities]]
*Consider risk of [[refeeding syndrome]] 

==Disposition==
*If mild, can be discharged after correction of acidosis, electrolytes, and hypovolemia
*If severe, admit 

==See Also==
*[[Alcoholic ketoacidosis]]
*[[Diabetic ketoacidosis]]

==External Links==


==References==
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[[Category:Endocrinology]]
[[Category:FEN]]