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October 7, 1999

Hyperglycemia and DKA

Question from Lancaster, Lancashire, Great Britain:

Is it possible for non-diabetic people with anorexia or those in a famine to develop any kind of ketoacidosis? Or is that not likely since both cases have insulin with which to use up stored glycogen and hence they rely less heavily and consistently on fat stores in the body?


Mild ketosis can occur outside of diabetes when someone eats too few calories and/or too little carbohydrate for their needs. This forces the body to burn fat for energy. Fats must be metabolized with some carbohydrate to burn cleanly. Ketones are acid waste products of incomplete fat metabolism. The body tries to eliminate these waste products both via the urine and on the breath. Some low carbohydrate diet programs use this as an indicator of “adequate” carbohydrate restriction, having people test their urine for ketones each morning. It is also not uncommon for young children to have a noticeable “fruity” smell on their breath in the morning after a long sleep. Their rapid metabolism drives the body to burn body fat stores after a lengthy fast. Ketones from low calorie or low carbohydrate intake disappear readily when food is eaten. Infrequent, mild ketosis is not dangerous but maintaining a ketotic state — for example for weight loss purposes — is dehydrating, usually produces nausea and may be risky for bones, kidneys, and the circulation.

Additional comments from Dr. Quick:

There’s also a different syndrome of ketoacidosis that can occur in people with alcoholism, which not surprisingly is called alcoholic ketoacidosis. It’s related to alcohol’s effects on the liver combined with malnutrition.