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Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes.
Diabetes Metab Res Rev 1999 Nov-Dec; 15(6):412-26DM

Abstract

Ketone bodies are produced by the liver and used peripherally as an energy source when glucose is not readily available. The two main ketone bodies are acetoacetate (AcAc) and 3-beta-hydroxybutyrate (3HB), while acetone is the third, and least abundant, ketone body. Ketones are always present in the blood and their levels increase during fasting and prolonged exercise. They are also found in the blood of neonates and pregnant women. Diabetes is the most common pathological cause of elevated blood ketones. In diabetic ketoacidosis (DKA), high levels of ketones are produced in response to low insulin levels and high levels of counterregulatory hormones. In acute DKA, the ketone body ratio (3HB:AcAc) rises from normal (1:1) to as high as 10:1. In response to insulin therapy, 3HB levels commonly decrease long before AcAc levels. The frequently employed nitroprusside test only detects AcAc in blood and urine. This test is inconvenient, does not assess the best indicator of ketone body levels (3HB), provides only a semiquantitative assessment of ketone levels and is associated with false-positive results. Recently, inexpensive quantitative tests of 3HB levels have become available for use with small blood samples (5-25 microl). These tests offer new options for monitoring and treating diabetes and other states characterized by the abnormal metabolism of ketone bodies.

Authors+Show Affiliations

Harvard Medical School, Joslin Clinic, One Joslin Place, Boston, MA 02215, USA. lori.laffel@joslin.harvard.edu

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

10634967

Citation

Laffel, L. "Ketone Bodies: a Review of Physiology, Pathophysiology and Application of Monitoring to Diabetes." Diabetes/metabolism Research and Reviews, vol. 15, no. 6, 1999, pp. 412-26.
Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):412-26.
Laffel, L. (1999). Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes/metabolism Research and Reviews, 15(6), pp. 412-26.
Laffel L. Ketone Bodies: a Review of Physiology, Pathophysiology and Application of Monitoring to Diabetes. Diabetes Metab Res Rev. 1999;15(6):412-26. PubMed PMID: 10634967.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. A1 - Laffel,L, PY - 2000/1/15/pubmed PY - 2000/2/26/medline PY - 2000/1/15/entrez SP - 412 EP - 26 JF - Diabetes/metabolism research and reviews JO - Diabetes Metab. Res. Rev. VL - 15 IS - 6 N2 - Ketone bodies are produced by the liver and used peripherally as an energy source when glucose is not readily available. The two main ketone bodies are acetoacetate (AcAc) and 3-beta-hydroxybutyrate (3HB), while acetone is the third, and least abundant, ketone body. Ketones are always present in the blood and their levels increase during fasting and prolonged exercise. They are also found in the blood of neonates and pregnant women. Diabetes is the most common pathological cause of elevated blood ketones. In diabetic ketoacidosis (DKA), high levels of ketones are produced in response to low insulin levels and high levels of counterregulatory hormones. In acute DKA, the ketone body ratio (3HB:AcAc) rises from normal (1:1) to as high as 10:1. In response to insulin therapy, 3HB levels commonly decrease long before AcAc levels. The frequently employed nitroprusside test only detects AcAc in blood and urine. This test is inconvenient, does not assess the best indicator of ketone body levels (3HB), provides only a semiquantitative assessment of ketone levels and is associated with false-positive results. Recently, inexpensive quantitative tests of 3HB levels have become available for use with small blood samples (5-25 microl). These tests offer new options for monitoring and treating diabetes and other states characterized by the abnormal metabolism of ketone bodies. SN - 1520-7552 UR - https://www.unboundmedicine.com/medline/citation/10634967/Ketone_bodies:_a_review_of_physiology_pathophysiology_and_application_of_monitoring_to_diabetes_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1520-7552&date=1999&volume=15&issue=6&spage=412 DB - PRIME DP - Unbound Medicine ER -