Diabetic ketoacidosis (DKA) remains a major problem of uncontrolled diabetes with significantly morbidity and mortality.
The worldwide immediate mortality related to DKA has decreased within the last decades but has not improved fundamentally.
The pathogenesis of ketoacidosis involves insulin deficiency (a complete lack of insulin production or a relative deficiency of insulin) and increased production of catabolic hormones like glucagon, cortisol, catecholamines, and growth hormones.
These changes result in an overproduction and underutilization of glucose, causing hyperglycemia. Simultaneously, abundant free fatty acids are converted to ketone bodies (acetoacetate, β-hydroxybutyrate (β-OHB), and acetone) due to increased lipolysis and decreased lipogenesis.
The relative proportion of Beta-hydroxybutyrate (BHB) in blood (78%) is higher than the proportion of the other ketone bodies; acetoacetate (20%) and acetone (2%).
Acetoacetate accumulates in blood, a small amount is converted to acetone by spontaneous decarboxylation; the greater portion of acetoacetate is converted to BHB.
The best early diagnosis of diabetic ketoacidosis or impending diabetic ketoacidosis is the measurement of Beta-Hydroxybutyrate (BOHB).