PDF OnlyCan a severe degree of ketoacidosis develop overnight?Schreiber, M; Steele, A; Goguen, J; Levin, A; Halperin, M Author Information Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. Journal of the American Society of Nephrology : JASN 7(2):p 192-197, February 1996. | DOI: 10.1681/ASN.V72192 Free Metrics Abstract Insulin-dependent diabetes mellitus in poor control, alcohol intake associated with extracellular fluid volume contraction, or hypoglycemia may each lead to an increased rate of production of ketoacids. Generally, several days of illness are required before ketoacidosis becomes severe. Two clinical examples are presented to suggest that a severe degree of ketoacidosis may develop over a short period of time, literally overnight. In both examples, there was the ingestion of a modest amount of ethanol. From a quantitative analysis of factors that may influence the rate of production and removal of ketoacids, the following were deduced. Contributing factors to the very rapid development of maximal ketoacidosis could include the absence of a lag period for the conversion of ethanol to acetyl-coenzyme A in the liver and an impaired ability of the brain and kidneys to oxidize ketoacids, especially if these ketoacids are produced very rapidly and/or if less metabolic work is performed by these organs. In special settings, ketoacidosis may develop more rapidly than is generally appreciated. Copyright © 1996 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.