Ketogenic vs Ketoacidosis

Ketosis is NOT Ketoacidosis

The difference between the two conditions is a matter of volume and flow rate*:

  • Ketoacidosis is a condition in which abnormal quantities of ketones are produced in an unregulated biochemical situation. In order to reach a state of ketoacidosis, the body has to be in a state of not producing enough insulin to regulate the flow of fatty acids and the creation of ketone bodies.
  • Benign dietary ketosis is a controlled, insulin regulated process which results in a mild release of fatty acids and ketone body production in response to low carbohydrate intake, and higher fat consumption.



Ketoacidosis: A feature of uncontrolled diabetes mellitus characterized by a combination of ketosis and acidosis. Ketosis is the accumulation of substances called keytones and ketone bodies in the blood. Acidosis is increased acidity of the blood.

Symptoms of ketoacidosis include slow, deep breathing with a fruity odor to the breath; confusion; frequent urination (polyuria); poor appetite; and eventually loss of consciousness.

The treatment of ketoacidosis is a matter of urgency and is usually done in a hospital. It may require the administration of intravenous fluids, insulin, andglucose, and the institution of changes in the person’s diet.



Ketoacidosis is a dangerous condition, where toxic levels of ketone bodies build up in the blood because the body is not producing insulin. Ketosis, on the other hand, results when the body has exhausted its stored glycogen and begins to burn fatty tissue for energy.


The process of ketosis is the basis of the many low-carb diets marketed to the public. In ketosis, the body does not have sufficient glucose or glycogen available to give cells what they need to create energy. The body then turns to fat cells as an energy source. Ketone bodies in the bloodstream are a natural product of this process.

These diets work, and ketosis is achieved, when carbohydrates are essentially eliminated from the diet. With minimal carbohydrate intake, there is little sugar to convert to glycogen. Without glycogen, the body breaks down and excretes fat cells, leaving ketones behind in the blood. In an ideal situation, this results in weight loss.

Ketones in the body can be toxic in high enough concentrations. The body often has small amounts of ketones in the bloodstream, including during the overnight period. This is a mild, natural reaction, with low levels of ketones (blood ketones at 1-3 millimolar) and a normal pH of 5, that reverses in the morning when the nightly fast is broken. Low levels of ketones in the bloodstream do not represent a danger to health.


Ketoacidosis occurs when blood sugar levels are high (meaning they are not being metabolized properly in the absence of insulin) and the body is experiencing dehydration. This means the normally small concentration of ketones in the bloodstream becomes much larger.

Ketoacidosis is a pathological condition where the body cannot control the level of ketones building up in the blood. The ketones are being excreted in the urine, but not fast enough to prevent the blood from becoming acidic. Acetone is the simplest ketone, so it is not uncommon that the breath of the patient smells like acetone, or has a “fruity” odor.

This increase in acidity of the blood causes significant damage to organs within the body. It is a serious condition that requires emergency treatment. Untreated ketoacidosis can be life-threatening.

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) can develop quickly, often within 24 hours. Excessive thirst, frequent urination, abdominal pain, nausea and vomiting, shortness of breath, weakness or fatigue, mental confusion and fruity-smelling breath are all symptoms. If these symptoms occur in conjunction with hyperglycemia and high levels of ketones in the urine (which may be tested with test strips available at the pharmacy), immediate medical attention should be sought.

Triggers for the development of Ketoacidosis might include illness (particularly one where there is a high fever and/or vomiting and diarrhea), failure to take insulin treatments in a timely manner, stress, heart attack, physical or emotional trauma or surgery. Alcohol or drug abuse – particularly cocaine – are also triggers.

DKA more commonly occurs in type 1 diabetes patients, or in late-stage type 2 diabetes patients who no longer manufacture insulin.

Sources: Mayo Clinic and Living Healthy360



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