A lot of people on the ketogenic diet often come across the notorious term “ketoacidosis” and wonder how it relates to ketosis. While Ketoacidosis sounds similar to ketosis, these are two very different things and should not be confused.
What is Ketoacidosis?
So what exactly is ketoacidosis and how does it affect the body? Ketoacidosis actually more properly refers to diabetic ketoacidosis (DKA) and is a very dangerous condition.
DKA is a life-threatening condition can happen due to extremely high levels of ketones in the body due to a lack of insulin, which results in the blood becoming too acidic. This can alter the functioning of internal organs like the liver and kidneys and requires immediate medical attention.
In non-diabetics, ketoacidosis is extremely rare.
What is Ketosis?
Ketosis, on the other hand, is simply the unharmful presence of ketones. When on a low-carb diet or during extensive fasting, your body will naturally move into a metabolic state of ketosis which prompts your body to produce ketones as it burns more fat.
While this means there will be a higher level of ketones in your blood, it’s not high enough to make the blood dangerously acidic as ketoacidosis does.
What Causes Ketoacidosis?
So now you might be wondering what causes ketoacidosis? Ketoacidosis generally occurs because of an insulin deficiency in diabetics (generally those who are type-1/insulin-dependent).
When experiencing an insulin deficiency, the fat cells and liver are not able to listen to or receive the signals from insulin that there is excess energy. This, in turn, will compel the liver and fat cells to go into starvation mode, even after a hearty meal.
What happens next is the fat cells will push triglycerides into the blood to give other cells energy while the liver mobilizes stored glycogen and provides the body with ketones and sugar it doesn’t really need.
The result of all of this is that blood sugar rises to dangerous levels (also known as uncontrolled hyperglycemia) while ketones build up in the blood due to the lack of insulin. The excess of ketones and sugar will begin drawing water out of the tissues, into the blood, and exiting the body through urine.
Since your body now has less water in the blood due to frequent urination, the ketones make the blood too acidic which pushes the body into a metabolic acidosis state. This ultimately leaves cells unable to carry out the necessary physiological processes for survival, which is why ketoacidosis can be fatal if left untreated.
Symptoms of Ketoacidosis
Ketoacidosis is something that develops quickly, usually within 24 hours or less. The most common symptoms are abdominal pain, rapid breathing, drowsiness, and vomiting.
People experiencing this condition will be dehydrated due to constant urination and have a higher heart rate, higher blood glucose levels, and low blood pressure.
Some symptoms aren’t as obvious as vomiting or drowsiness, and so some testing is necessary to determine if you’re experiencing them.
Bear in mind, if you’re diabetic and feel these symptoms coming on, you should head to the nearest urgent care or hospital just to be safe. Again, ketoacidosis is a life-threatening condition and needs to be treated quickly.
Testing for Ketoacidosis Symptoms
Some of the symptoms from above can be due to a variety of other conditions, and may not necessarily mean you are experiencing ketoacidosis. Before rushing to the hospital, test for the most common ketoacidosis symptoms.
Check if you are dehydrated
You can test for dehydration by pinching the skin on your forehead that is just above and between your eyebrows. Normally, the skin in this area will return to its original position after being pinched, but when mildly dehydrated, it will stay folded for less than two seconds.
Between 2-10 seconds means moderate dehydration, and staying folded for longer means the body is severely dehydrated.
Test your heart rate
To test your resting heart rate, first ensure that you are fully relaxed. You’ll want to check the pulse at your wrists by placing two fingers between the bone and tendon over the space located on the thumb side of the wrist.
Grab a watch or stopwatch and count how many heartbeats (or pulses) you feel for 15 seconds, and multiply that number by 4. This is your resting heart rate. So 25 beats in 15 seconds would give you a heart rate of 100 beats per minute.
Check your blood pressure
Unless you happen to have a blood pressure cuff lying around, it can be hard to check what your blood pressure is. You can tell if your blood pressure is low if you are experiencing some of these symptoms:
- Blurry vision
- Lack of concentration
Many pharmacies and grocery stores have blood pressure monitors that you can use for free as well.
Check blood sugar levels
If you have diabetes, it’s essentially mandatory to have a blood sugar meter at hand. They are cheap and easy to find. All you have to is prick your finger and use a drop of blood to get a reading.
In case you don’t have a blood sugar meter, watch for the traditional symptoms of hyperglycemia, such as:
- Increased thirst
- Blurry vision
- Frequent urination
- Lack of concentration
If you think you might be experiencing ketoacidosis, it’s important to contact your doctor as soon as possible so they can help direct you appropriately.
The best way to prevent ketoacidosis if you’re diabetic is to ensure you have adequate insulin in the body. If you have adequate insulin and it’s functioning properly, your blood sugar and ketone levels will not build up to a point that makes the blood dangerously acidic.
If you are diabetic, be sure to consult with your doctor prior to adjusting your nutritional habits, especially if you plan to do the keto diet.
Ketoacidosis is a very serious issue, and can even become lethal. In most cases, however, it’s entirely preventable. It most often occurs when those with type-1 diabetes aren’t mindful of their blood sugar levels and insulin use.
 Kerl, M. E. (2001). Diabetic ketoacidosis: pathophysiology and clinical and laboratory presentation. Compendium, 23(3), 220-228.
 Zinn, C., Wood, M., Williden, M., Chatterton, S., & Maunder, E. (2017). Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes. Journal of the International Society of Sports Nutrition, 14(1), 22.
 Adair R Gosmanov, M.D., Ph.D., F.A.C.E., Elvira O Gosmanova, M.D., F.A.S.N., and Abbas E Kitabchi, M.D., Ph.D., M.A.C.E. Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS). South Dartmouth (MA): MDText.com, Inc.; 2000-.
 Gilbert, J. D., & Byard, R. W. (2018). Fatal diabetic ketoacidosis—a potential complication of MDMA (ecstasy) use. Journal of forensic sciences, 63(3), 939-941.
 Canavan, A., & Arant Jr, B. S. (2009). Diagnosis and management of dehydration in children. children, 100(17), 18-19.