This document discusses ketosis, including the three main types of ketone bodies, acetone, acetoacetic acid, and beta-hydroxybutyric acid. It describes how ketosis occurs when the rate of ketone body synthesis exceeds the rate of their utilization, as seen in starvation and diabetes mellitus. Factors that can aggravate ketosis are also summarized, such as decreased carbohydrate availability and increased free fatty acid levels. The clinical effects of ketosis include ketoacidosis, dehydration, and potentially death if left untreated. Treatment involves administering insulin, glucose, and bicarbonate to correct acidosis.

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 (Rotheras Test)
 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 AGGREVATING KETOSIS
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 AGGREVATING KETOSIS
INSULIN / GLUCAGON RATIO DECREASED
INCREASED LIPOLYSIS IN ADIPOSE TISSUE
INCREASED ACETYL Co A
KETONE BODIES

10. FACTORS AGGREVATING KETOSIS
 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