Starvation and diabetes mellitus can lead on to ketoacidosis which of the following features is in our of ketoacidosis due to diabetes mellitus?
Ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies. Ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. The three major types of ketosis are: Starvation ketosis Alcoholic ketoacidosis Diabetic ketoacidosis Starvation Ketoacidosis: Occurs secondary to starvation, is due to a diminished insulin secretion, that leads to an increase in lipolysis and ketogenesis. The acidosis even with prolonged fasting is only mild to moderate. Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency and is defined by the American Diabetes Association's (ADA) diagnostic criteria of Hyperglycemia , Acidosis (aerial pH Ketosis (moderate ketonuria or ketonemia) The metabolic differences between diabetes and starvation include- Insulin levels: The level of insulin is decreased in both diabetes and starvation. It is more decreased in case of diabetes (viually absent in type I diabetes). There is relative excess of glucagon in both the cases. Glucagon acts through elevation in CAMP level. Blood glucose levels: Diabetics exhibit a characteristic hyperglycemia where as in starvation the individual maintain a blood glucose level that is near to normal Ketosis: The mobilization of fatty acids from adipose tissue and hepatic ketogencsis are greater in diabetes than in starvation. As a result the ketoacidosis observed in diabetes in much more severe than that observed during starvation. Factors DKA Starvation pH | normal Plasma glucose | normal Glycosuria + + ---- Total plasma ketones || Mild | Anion gap | Mild | Osmolality | normal Ref: Lippincott's illustrated reviews Biochemistry, 2nd Edition, Page 297.