What is Starvation Ketoacidosis & How Is it Treated? | Causes, Symptoms, and Complications of Starvation Ketoacidosis

Starvation ketoacidosis occurs when a person has undergone fasting for an extended period of time and there is not enough glucose for energy. The body breaks down fatty acids to use as an energy source. This leads to an increase in ketones in the body.

Starvation ketoacidosis is a rare condition but a few people are more at risk of suffering from it. There are various reasons, why a person would end up fasting. These include:

• Eating disorders
• Economic factors
• Difficulty in swallowing
• Cancer

In mild ketosis, the body uses fat as energy and this occurs 12-14 hours after fasting.⁽¹⁾ In ketoacidosis, there is a build-up of ketones that make the blood turn acidic. In starvation ketoacidosis, once the body runs out of fat, muscle breakdown starts and releases amino acids and lactate into the blood.

The transition from ketosis to ketoacidosis takes 2-3 days after fasting and after a few more days muscle breakdown starts occurring.⁽¹⁾

Other than starvation ketoacidosis, there are two other types of ketoacidosis, which include:

• Diabetic ketoacidosis: It occurs when a person runs out of insulin and can be life-threatening.
• Alcohol ketoacidosis: It occurs in people who drink an excessive amount of alcohol that results in vomiting, anxiety and abdominal pain.

The causes of starvation ketoacidosis include:

• Gastric banding
• Eating disorders
• Malnutrition
• Ketogenic diet

People with easy access to food have a lesser risk of developing starvation ketoacidosis. An intermittent diet combined with a ketogenic diet puts a person at a higher risk of developing ketoacidosis.

Those interested in following special diets such as the keto diet should speak to the doctor before starting them.

People who are more at risk of starvation ketoacidosis are:

• Those with difficulty in swallowing mostly after surgery and radiation
• Those having an underlying condition or any disease
• Those who spend a long time without proper nutrition

The signs and symptoms of starvation ketoacidosis include:

• Low body temperature
• Tooth decay
• Minimal body fat
• Low muscle mass
• Obvious bony prominences
• Low pulse rate
• Low blood pressure
• Thin, dry, and sparse hair

A case report gave information about people with psychiatric disorders and starvation ketoacidosis. It was concluded that an accurate diagnosis was more difficult in people with psychiatric disorders as they were not able to give an accurate history of their eating habits and health.

Starvation ketoacidosis occurs due to the lack of glucose after long periods of starvation therefore to come to a diagnosis, a doctor also looks for weight loss.

Those experiencing unexplained weight loss should speak with the doctor to tell him about any other symptom, their diet, and any underlying health condition.

If starvation ketoacidosis is diagnosed, the person is treated accordingly.

In the treatment of starvation ketoacidosis, the doctor needs to monitor the electrolytes. During this process, he introduced foods and replaces potassium, phosphate, and magnesium. A case study was done on a person with anorexia who had developed starvation ketoacidosis.⁽²⁾ This person was treated with dextrose solution for 15 hours and starvation ketoacidosis improved.

With proper treatment and treating the underlying condition, the person can make full recovery.

As starvation ketoacidosis occurs, a person’s body starts looking thinner and drawn out and the bones would become more pronounced. The person may feel lethargic as the body has begun to break down muscles.

Starvation ketoacidosis is the most uncommon form of ketoacidosis. But recovery is possible after treatment.