Ramesh Ramanathan, Kanagasingam Arulmoly, Sabrina Sithy, Anushanth Uthayakumar
Medicine, Teaching Hospital-Batticaloa, Batticaloa, LKA.
Cureus. 2023 Jun 5;15(6):e39962. doi: 10.7759/cureus.39962. eCollection 2023 Jun.
Ketone bodies are important energy sources for the body and are produced by the liver when the body is in a deficiency state of glucose, which is used in the peripheral tissues to provide energy. There are several ketone bodies that are produced by the liver, of which two are important: acetoacetate and beta-hydroxybutyrate. Even though ketone bodies are always present in the body, they are minimal when a person is not fasting. Ketone bodies are produced by the oxidation of fatty acids to fulfill the metabolic needs of tissues, especially the brain. The biochemical reactions of forming ketone bodies are triggered by a lack of insulin and an elevated glucagon level in the blood. Both cause unopposed lipolysis and free fatty acid oxidation resulting in the production of ketone bodies and eventually high anion gap metabolic acidosis. We present a case of young healthy female who presented with euglycemic ketoacidosis after involving prolonged fasting for her religious ceremony. She also physically exerted quite more during her fasting. With a detailed history and excluding other possibilities, we made the diagnosis of starvation ketoacidosis. She improved well with the treatment and established her pre-morbid condition in our review.
酮体是身体重要的能量来源，当身体处于葡萄糖缺乏状态时由肝脏产生，在外周组织中用于提供能量。肝脏会产生几种酮体，其中两种较为重要：乙酰乙酸和β-羟基丁酸。尽管酮体始终存在于体内，但在非禁食状态下含量极少。酮体通过脂肪酸氧化产生，以满足组织尤其是大脑的代谢需求。形成酮体的生化反应由血液中胰岛素缺乏和胰高血糖素水平升高引发。这两者都会导致不受抑制的脂肪分解和游离脂肪酸氧化，从而产生酮体，并最终导致高阴离子间隙代谢性酸中毒。我们报告一例年轻健康女性病例，她在为宗教仪式长时间禁食后出现了正常血糖性酮症酸中毒。她在禁食期间体力消耗也较多。通过详细询问病史并排除其他可能性，我们诊断为饥饿性酮症酸中毒。经治疗后她恢复良好，在我们的复查中恢复到了病前状态。
