KETOSIS

DR ROHINI C SANE

PROFESSOR

DEPARTMENT OF BIOCHEMISTRY

DY PATIL MEDICAL COLLEGE MAURITIUS

TYPES OF KETONE BODIES

ACETONE ,

ACETO ACETIC ACID

BETA HYDROXY BUTYRIC ACID

PROPERTIES OF KETONE BODIES

WATER SOLUBLE

ENERGY YEILDING (ACETONE CANNOT BE METABOLISED )

KETOGENESIS

Acetyl Co A

Co ASH

Acetyl Co A

KETONEMIA

KETOSIS

SERUM NORMAL CONCENTRATION---- 1 mg/ml

Urine-----Trace (Rotheras Test)

KETONEMIA----( INCREASED CONCENTRATION OF SERUM KETONE BODIES

>100mg / dl)

KETONURIA-----(INCREASED CONCENTRATION IN URINE >500mg /dl)

KETOSIS---- KETONEMIA + KETONURIA

RATE OF SYNTHESIS > RATE OF UTILIZATION

DIEBETIS MELITUS / STARVATION

FACTORS AGGREVATING KETOSISDECREASED CONCENTRATION OF OAA (AS GLUCONEOGENESIS---INCREASED )

DECREASED ACETYL Co A UTILISATION

DECREASED TCA

INCREASED CONCENTRATION OF ACETYL Co A

FACTORS AGGREVATING KETOSISINCREASED FREE FATTY ACIDS

DECREASED ACETYL Co A CARBOXYLASE

DECREASED MALONYL Co A

INCREASED CARNITINE PALMITOYL TRANSFERASE

INCREASED ACYL CO A OXIDATION

INCREASED ACETYL COA

FACTORS AGGREVATING KETOSISINSULIN / GLUCAGON RATIO DECREASED

INCREASED LIPOLYSIS IN ADIPOSE TISSUE

INCREASED ACETYL Co A

KETONE BODIES

FACTORS AGGREVATING KETOSIS

KETOGENIC AMINO ACIDS

LEUCINE

LYSINE

TYROSINE

STARVATION

BETA OXIDATION ENZYMES (INCREASED) INCREASED HORMONE SENSITIVE LIPASE I

ACTIVITY

Acetyl Co A

KETONE BODIES HORMONES

FFA

Acetyl Co A

KETONE BODIES (BRAIN 48HR-20%

7 DAYS-60%

40 DAYS 70% )

STARVATIONMANIFESTATIONS

DISPLACEMENT OF VISCERAL ORGANS (ADIPOSE TISSUE

THINS OUT )

SKIN HANGS LOOSE

DECREASED ACETYL Co A CARBOXYLASE

DECREASED CITRATE SYNTHETASE

INCREASED TRANSLOCATION OF CITRATE TO CYTOSOL

DECREASED FATTY ACID SYNTHESIS

METABOLIC KETOACIDOSIS

HYPERVENTILATION

BREATH ---ACETONE –FRUITY ODOUR

DECREASED BICARBONATE

OSMOTIC DIURESIS

DEHYDRATION ,KETONURIA

LOSS OF SODIUM AGGRIVATING DEHYDRATION

INCREASED ACIDITY IN URINE

INCREASED AMMONIUM SECRETION &EXCRETION OF AMMONIUM CHLORIDE

FATTY LIVER( CARBOHYDRATE DECREASED ---DECREASED ALPHA GLYCEROL P ----DECREASED VLDL )------ACCUMULATION FAT IN LIVER

COMA

DEATH

EFFECTS OF KETOSIS

TREATMENT OF KETOSIS ( STARVATION)

INSULIN

GLUCOSE

ASPARTATE ----OAA---TCA-----ACETYL COA

CORRECTION OF ACIDOSIS& BICARBONATE

TREATMENT OF DIEBETIS KETOACIDOSIS

INSULIN

ASPARTATE

GLUCAGON STIMULATES KETOGENESIS

INSULIN INHIBITS KETOGENESIS