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Ketoacidosis vs. Ketosis: The Difference Between a Complication and a Metabolic State

By Fitoru | 26 July 2019
woman with Ketoacidosis

Though their names are similar, ketoacidosis and ketosis are completely different conditions, one destructive and life-threatening and the other harmless and often beneficial. This article details each of these terms to clarify the difference between ketoacidosis vs. ketosis, the symptoms of each, and how you can treat one while utilizing the other for its health benefits.

What Are Ketones?

To understand these conditions, it’s important to know what ketones are. Ketone bodies are molecules that the body can use to fuel muscles and other vital processes. More often our body uses sugar (glucose) for energy because it’s simpler and breaks down faster, but in cases of low-carb diets, fasting, or in extreme circumstances starvation, the liver will step in to produce ketones by breaking down fat and fatty acids for this alternative energy source. 

Ketoacidosis vs. Ketosis: Which Is Which?

We’ll start with the basic definitions of these two conditions.

Ketoacidosis: A Diabetes Mellitus Complication

Ketoacidosis is a common way to refer to diabetic ketoacidosis (DKA), which mostly arises as a complication of type 1 diabetes mellitus. 

Type 1 diabetes is a medical condition characterized by the inability of the pancreas to produce enough insulin to control a person’s blood sugar levels. It can develop slowly with symptoms that come on suddenly once glucose levels quickly rise, and it is usually diagnosed around the age of 14.

Ketoacidosis occurs when a person with type 1 or sometimes type 2 diabetes has extremely low levels of insulin available to process blood sugar into energy. This leads to a dangerous buildup of useable blood sugar, all while the body desperately burns fat for ketones to use as energy instead, leading to extremely high levels of ketones. This, in turn, causes the blood to become acidic, which alters the functioning of vital organs like the liver and kidneys. 

This critical condition has a very fast onset and requires immediate medical treatment. It can be caused by improper diet, unexpected illness, or inadequate levels or dosages of insulin. Sometimes it is the first sign for someone undiagnosed that lets them know they have diabetes.

Symptoms of Ketoacidosis

The symptoms of this life-threatening condition include:

  • Extreme thirst
  • Dry mouth/skin
  • Flushed face
  • Rapid breathing
  • Abdominal pain
  • Fruity-smelling breath not unlike nail polish remover
  • Frequent urination
  • High blood sugar levels
  • High ketone levels in urine
  • Nausea and/or vomiting
  • Confusion
  • Fatigue

Once diagnosed and treated by a doctor, you may be instructed to use ketone test strips to monitor ketone levels in the future to avoid another extreme circumstance. The American Diabetes Association recommends checking your ketone levels every 4 to 6 hours if you have a cold or flu, or if your blood sugar levels are higher than 240 milligrams per deciliter (mg/dL).

Ketoacidosis is the leading cause of death in patients under 24 who are diabetic, with a death rate of 2% to 5% of those who develop it, and should be taken as seriously as possible.

Ketoacidosis vs. ketosis: which one is dangerous?

Ketosis: A Different Metabolic State

While an overwhelming amount of ketones in the blood makes our blood acidic, ketones are no more dangerous than blood sugar: too much of either one is harmful, but in normal amounts they both function as fuel sources for our bodies. Ketones in fact are unique, as they can more easily cross the blood-brain barrier and possibly deliver more energy to our brains, which is one of the many reasons why some people choose a ketogenic meal plan and work to replace glucose energy with ketones bodies.

The ketogenic or keto diet is a low-carb, moderate-protein, high-fat diet that seeks to put the body in a state of nutritional ketosis. The body enters ketosis when it is denied easy access to the simple sugar in carbs, and instead is forced to break down dietary fat and the fat stored on our bodies. This causes rapid yet safe weight loss, and while at first it increases the amount of blood ketones and causes a few flu-like symptoms, the body is able to quickly adapt and the symptoms disappear.

Symptoms of Ketosis

Some of the symptoms of ketosis include:

  • Rapid weight loss
  • Dry mouth
  • Digestive upset
  • Fruity-smelling breath (aka keto breath)
  • Short-term fatigue
  • Loss of appetite
  • Sleep difficulties
  • Enhanced focus

While many of the symptoms are the same, being in a state of ketosis is not harmful, and can happen sometimes without a person noticing, as in circumstances of eating a low-carbohydrate diet, consuming too much alcohol, or fasting. When achieved intentionally it can help people burn fat quickly, which leads to healthy weight loss and may even be a successful tactic for managing diabetes (though it’s advised that you consult your doctor before attempting it if you have either a type 1 or type 2 diabetes diagnosis).

Risk Factors for Ketoacidosis

Knowing how serious ketoacidosis is, it may make you wary of attempting a ketogenic diet despite the health benefits associated with going keto. Here are the risk factors involved in ketoacidosis, to help illustrate how different a situation it is from keto dieting.

Possible triggers for ketoacidosis include:

  • A heart attack
  • Malnutrition and extreme fasting
  • Excessive alcohol consumption or benders
  • Severe dehydration
  • Misuse of drugs like cocaine
  • Acute pancreatitis
  • Adverse reaction to medications
  • Major illnesses like sepsis
  • Extreme stress

The reason ketoacidosis is most frequently diagnosed in type 1 diabetes patients is because even type 2 diabetes, though a serious, chronic medical condition in its own right, rarely leads to the kind of low levels of insulin associated with type 1 diabetes. As long as one’s blood sugar is within normal range, diabetics can have low or moderate levels of ketones in their blood without being at any elevated risk of developing diabetic ketoacidosis. It’s the lack of insulin that causes a crisis, not normal levels of ketone bodies.

Likewise, a person who is not diabetic or pre-diabetic who switches to a keto diet is even less likely to have anything but mild ketosis symptoms without a severe underlying cause like those listed above.

Ketoacidosis Treatment

If you are in a state of ketosis, you have no need for treatment, and you may even be happy about the amount of dangerous body fat you’re burning up. If you have ketoacidosis however, you desperately need medical treatment, and here is what that treatment might entail.

  • Oral or intravenous fluid replacement
  • An insulin drip to return your blood sugar levels to below 240 mg/dL
  • Intravenous replacement of electrolytes like sodium, potassium, or chloride
  • Blood tests to rule out any other medical conditions or infections

The Keto Confusion Explained

Now you know what divides ketoacidosis vs. ketosis. Ketosis is one of the safest ways to lose weight quickly, and eating a ketogenic diet could also protect you from developing ketoacidosis if you are diabetic. Not only does the keto diet call for a low-carb (and by extension, low-sugar) diet, but it can also help those who are obese or overweight lose body fat. In monitoring your level of ketones and your blood glucose levels simultaneously, it can help drastically reduce the chances of ketoacidosis developing suddenly. 

While diabetic ketoacidosis can often be cleared up in as few as 48 hours, if it is not detected early enough, or if there are other underlying health problems at play, it can be fatal to both young and old. Consult your doctor if you are diabetic or otherwise at-risk of developing ketoacidosis, and find out whether getting into a fat-burning state of ketosis could help keep you safe.


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