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 (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