Version July 2025
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What are ketosis and ketoacidosis? —
Ketosis is when chemicals called "ketones" build up in the blood. Ketoacidosis is when this ketone buildup makes the acid level in the blood too high.
Severe ketoacidosis is an emergency and needs treatment right away.
What causes ketoacidosis? —
Normally, the body breaks down sugar as a source of energy. If it cannot do this for some reason, the body starts burning fat for energy instead. This causes ketones to build up.
The most common cause of ketoacidosis is diabetes that is not well managed. But other things can also cause it, including:
●Fasting ketosis – "Fasting" means not eating anything for a period of time. Normally, your body gets energy from the foods you eat, particularly foods with carbohydrates ("carbs"). After about 12 to 14 hours of not eating, or eating a diet very low in carbs, the body starts to use fat for energy instead. Fasting ketosis does not usually lead to severe ketoacidosis or cause health problems. But it can.
●Alcoholic ketoacidosis – People with alcohol use disorder sometimes get ketoacidosis. This usually happens after an episode of binge drinking, followed by several days of not eating. As the alcohol level in the blood decreases, the body starts to use fats for energy. This causes acid levels to increase.
What are the symptoms of ketoacidosis? —
Fasting ketosis does not usually cause symptoms.
People with ketoacidosis often have symptoms. These might include:
●Nausea and vomiting
●Belly pain or tenderness
●Signs of fluid loss, like dry mouth and a fast heart rate
●Breathing faster than normal
Should I see a doctor? —
Yes. See your doctor or nurse right away if you have the symptoms listed above, especially if you have been fasting or drinking alcohol.
Is there a test for ketoacidosis? —
Yes. If your doctor or nurse thinks you might have ketoacidosis, they will do an exam and ask questions about your symptoms, diet, and alcohol use. They will also do tests, such as:
●Blood tests to check your levels of sugar, ketones, and "electrolytes"
●A urine test to check for ketones
If your doctor or nurse is not sure what caused your ketoacidosis, they can do other tests, too.
How is ketoacidosis treated? —
Treatment is usually done at the hospital. It involves getting fluids by IV. (An IV is a thin tube that goes into a vein.) This helps replace fluids you have lost. It also helps your sugar and electrolyte levels return to normal.
Depending on your situation, you might need other treatment, too. For example:
●If you have low levels of potassium, phosphorus, or magnesium, you might need extra of these minerals.
●If you have alcohol use disorder, you might need a medicine called thiamine. This is given by IV.
How can I prevent getting ketoacidosis? —
You can limit or avoid alcohol. If you are having trouble, talk to your doctor or nurse. There are treatments that can help.
Patient education: Diabetic ketoacidosis (The Basics)
Patient education: Electrolyte panel (The Basics)
Patient education: Hypovolemia in adults (The Basics)
Patient education: Low-carbohydrate diet (The Basics)
Patient education: Alcohol use – When is drinking a problem? (The Basics)
Patient education: Alcohol use — when is drinking a problem? (Beyond the Basics)
