Ketosis

A comprehensive presentation on ketosis, its symptoms & management.

1. KETOSIS
DR ROHINI C SANE
PROFESSOR
DEPARTMENT OF BIOCHEMISTRY
DY PATIL MEDICAL COLLEGE MAURITIUS

2. TYPES OF KETONE BODIES
ACETONE ,
ACETO ACETIC ACID
BETA HYDROXY BUTYRIC ACID

3. PROPERTIES OF KETONE BODIES
WATER SOLUBLE
ENERGY YEILDING (ACETONE CANNOT BE METABOLISED )

4. KETOGENESIS
Acetyl Co A
Co ASH
Acetyl Co A

5. KETONEMIA

6. KETOSIS
SERUM NORMAL CONCENTRATION----1 mg/ml
Urine-----Trace (RotherasTest)
KETONEMIA----( INCREASED CONCENTRATION OF SERUM KETONE BODIES
>100mg / dl)
KETONURIA-----(INCREASED CONCENTRATION IN URINE >500mg /dl)
KETOSIS----KETONEMIA + KETONURIA
RATE OF SYNTHESIS > RATE OF UTILIZATION
DIEBETIS MELITUS / STARVATION

7. FACTORS AGGREVATING KETOSIS
DECREASED CONCENTRATION OF OAA (AS GLUCONEOGENESIS ---INCREASED )
DECREASED ACETYL Co A UTILISATION
DECREASED TCA
INCREASED CONCENTRATION OF ACETYL Co A

8. FACTORS AGGREVATINGKETOSIS
INCREASED FREE FATTY ACIDS
DECREASED ACETYL Co A CARBOXYLASE
DECREASED MALONYL Co A
INCREASED CARNITINE PALMITOYL TRANSFERASE
INCREASED ACYL CO A OXIDATION
INCREASED ACETYL COA

9. FACTORS AGGREVATINGKETOSIS
INSULIN / GLUCAGON RATIO DECREASED
INCREASED LIPOLYSIS IN ADIPOSE TISSUE
INCREASED ACETYL Co A
KETONE BODIES

10. FACTORS AGGREVATINGKETOSIS
KETOGENIC AMINO ACIDS
LEUCINE
LYSINE
TYROSINE

11. STARVATION
BETA OXIDATION ENZYMES (INCREASED) INCREASED HORMONE
SENSITIVE LIPASE I
ACTIVITY
Acetyl Co A
KETONE BODIES HORMONES
FFA
Acetyl Co A
KETONE BODIES (BRAIN 48HR-20%
7 DAYS-60%
40 DAYS 70% )

12. STARVATION
MANIFESTATIONS
DISPLACEMENT OF VISCERAL ORGANS (ADIPOSE TISSUE
THINS OUT )
SKIN HANGS LOOSE
DECREASED ACETYL Co A CARBOXYLASE
DECREASED CITRATE SYNTHETASE
INCREASED TRANSLOCATION OF CITRATE TO CYTOSOL
DECREASED FATTY ACID SYNTHESIS

13. METABOLIC KETOACIDOSIS
HYPERVENTILATION
BREATH ---ACETONE –FRUITY ODOUR
DECREASED BICARBONATE
OSMOTIC DIURESIS
DEHYDRATION ,KETONURIA
LOSS OF SODIUM AGGRIVATING DEHYDRATION
INCREASED ACIDITY IN URINE
INCREASED AMMONIUM SECRETION &EXCRETION OF AMMONIUM
CHLORIDE
FATTY LIVER( CARBOHYDRATE DECREASED ---DECREASED ALPHA
GLYCEROL P ----DECREASED VLDL )------ACCUMULATION FAT IN LIVER
COMA
DEATH
EFFECTS OF KETOSIS

14. TREATMENT OF KETOSIS ( STARVATION)
INSULIN
GLUCOSE
ASPARTATE ----OAA---TCA-----ACETYL COA
CORRECTION OF ACIDOSIS& BICARBONATE

15. TREATMENT OF DIEBETIS KETOACIDOSIS
INSULIN
ASPARTATE
GLUCAGON STIMULATES KETOGENESIS
INSULIN INHIBITS KETOGENESIS