Ketosis

What Is Ketosis?

Ketosis is a metabolic state characterized by elevated circulating ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) in the blood, occurring when the body breaks down fatty acids for energy due to carbohydrate deprivation or insulin deficiency (diabetic ketoacidosis / DKA).

Why Ketosis Matters on the Fireground

Severe uncontrolled ketosis in Type 1 diabetics leads to Diabetic Ketoacidosis (DKA), presenting with metabolic acidosis, Kussmaul respirations (deep, rapid breathing attempting to blow off CO2), fruity acetone breath odor, hyperglycemia (> 300 mg/dL), and altered mental status.

Relevant NFPA Standards

• NREMT Standards: National Registry of Emergency Medical Technicians Practice Standards
• NFPA 455: Standard for Emergency Medical Services (EMS)

Field Procedures & Tactical Steps

1. Measure capillary blood glucose (glucometer shows high reading, typically > 300 mg/dL).
2. Assess respiratory rate and pattern — identify Kussmaul breathing (deep, rapid, sighing respirations).
3. Check for classic DKA signs: fruity/sweet acetone breath odor, dry mucous membranes, tachycardia, and abdominal pain.
4. Establish IV access and initiate Normal Saline 0.9% fluid resuscitation (1,000 mL bolus) to correct severe dehydration.
5. Monitor cardiac rhythm on ECG monitor (watching for hyperkalemia signs like peaked T-waves).

Common Context & Application

Encountered on EMS calls for diabetic emergencies, severe dehydration, altered mental status, and metabolic acidosis.

Frequently Asked Questions about Ketosis