Relationship of blood acetoacetate and 3 hydroxybutyrate in diabetes

SUMMARY. The ratio of blood ketone bodies 3-hydroxybutyrate to acetoacetate, once thought to be fairly constant, has been shown to vary from to Ketone bodies are three water-soluble molecules containing the ketone group that are produced by the liver from fatty acids during periods of low food intake ( fasting), carbohydrate restrictive diets, starvation, prolonged intense exercise, alcoholism or in untreated (or inadequately treated) type 1 diabetes mellitus. Beta-hydroxybutyrate is a reduced form of. Abstract. The ratio of blood ketone bodies 3-hydroxybutyrate to acetoacetate, once thought to be fairly constant, has been shown to vary from to

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Ketone bodies

The incidence of ketoacidosis was 7. The area under the ROC curve for the capacity to predict ketoacidosis was significantly higher for blood ketones 0. The hospitalization rate was No difference was seen between the insulin treated patients and the other ones.

relationship of blood acetoacetate and 3 hydroxybutyrate in diabetes

This RR was similar to that observed for blood ketones between 0. The area under the ROC curve for the capacity to predict hospitalization was significantly greater for blood ketones 0.

Relationship of blood acetoacetate and 3-hydroxybutyrate in diabetes.

Discussion This study compared urine ketones, the reference test for detection of ketoacidosis, and blood ketones in hyperglycaemic patients attending the Emergency Department. They also confirm the exponential relationship between urine ketones and blood ketones and the marked variability of blood ketones among patients with high urine ketones. To determine which of the two tests more accurately reflected insulin deficiency, we studied the correlation between the two tests and the RRs of ketoacidosis or hospitalization.

Acetyl-CoA with the acetyl group indicated in blue. Fats stored in adipose tissue are released from the fat cells into the blood as free fatty acids and glycerol when insulin levels are low and glucagon and epinephrine levels in the blood are high. This occurs between meals, during fasting, starvation and strenuous exercise, when blood glucose levels are likely to fall.

Fatty acids are very high energy fuels, and are taken up by all metabolizing cells that have mitochondria.

Relationship of blood acetoacetate and 3-hydroxybutyrate in diabetes.

This is because fatty acids can only be metabolized in the mitochondria. In all other tissues the fatty acids that enter the metabolizing cells are combined with co-enzyme A to form acyl-CoA chains.

relationship of blood acetoacetate and 3 hydroxybutyrate in diabetes

This results in the complete combustion of the acetyl group of acetyl-CoA see diagram above, on the right to CO2 and water. The energy released in this process is captured in the form of 1 GTP and 11 ATP molecules per acetyl group or acetic acid molecule oxidized.

Ketone bodies - Wikipedia

In the liver oxaloacetate is wholly or partially diverted into the gluconeogenic pathway during fasting, starvation, a low carbohydrate diet, prolonged strenuous exercise, and in uncontrolled type 1 diabetes mellitus. Under these circumstances oxaloacetate is hydrogenated to malate which is then removed from the mitochondrion to be converted into glucose in the cytoplasm of the liver cells, from where the glucose is released into the blood.

relationship of blood acetoacetate and 3 hydroxybutyrate in diabetes

Under these circumstances acetyl-CoA is diverted to the formation of acetoacetate and beta-hydroxybutyrate. The ketone bodies are released by the liver into the blood. All cells with mitochondria can take ketone bodies up from the blood and reconvert them into acetyl-CoA, which can then be used as fuel in their citric acid cycles, as no other tissue can divert its oxaloacetate into the gluconeogenic pathway in the way that the liver does this.

Unlike free fatty acids, ketone bodies can cross the blood-brain barrier and are therefore available as fuel for the cells of the central nervous systemacting as a substitute for glucose, on which these cells normally survive. Acetoacetate has a highly characteristic smell, for the people who can detect this smell, which occurs in the breath and urine during ketosis.

relationship of blood acetoacetate and 3 hydroxybutyrate in diabetes

Ketone bodies are transported from the liver to other tissues, where acetoacetate and beta-hydroxybutyrate can be reconverted to acetyl-CoA to produce reducing equivalents NADH and FADH2via the citric acid cycle.