Fasting Or Starving? Measurement of Blood Ketone Levels in 100 Fasted Elective and Emergency Adult Surgical Patients at An Australian Tertiary Hospital

Burstal, Richard; Reilly, Jennifer; Burstal, B.

doi:10.1177/0310057x1804600506

Cited by 18 publications

(10 citation statements)

References 14 publications

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“…The rate of ketosis in our cohort is lower than that seen in acutely unwell children without diabetes presenting to the ED, where those with BHB ≥ 1.2 mmol/L or higher comprised 34.4% of the cohort [4]. However, the frequency of hyperketonemia in ED in our series was higher than that seen amongst patients without diabetes fasting for surgical procedures, where it was only 3% [14]. This difference in the rate of ketosis may suggest that fasting or reduced oral intake alone is not responsible for the development of ketosis.…”

Section: Discussionmentioning

confidence: 65%

The Significance of an Increased Beta-Hydroxybutyrate at Presentation to the Emergency Department in Patients with Diabetes in the Absence of a Hyperglycemic Emergency

Depczynski

Lee

Varndell

et al. 2019

Journal of Diabetes Research

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The significance of hyperketonemia in adults with diabetes presenting to the emergency department with acute illness, not due to a diabetic hyperglycemic emergency, has not been well characterized. Adult patients with diabetes presenting to the emergency department who had venous blood gas and beta-hydroxybutyrate levels measured whilst in the emergency department were retrospectively evaluated for the relationship between BHB and clinical outcomes. Over 6 months, 404 patients with diabetes had at least one beta-hydroxybutyrate level measured in the emergency department. There were 23 admissions for diabetic ketoacidosis (DKA) or hyperosmolar state. Of the remainder, 58 patients had a beta-hydroxybutyrate ≥ 1 mmol/L; this group had a higher glucose at presentation (19.0 (8.8) versus 10.4 (9.9) mmol/L), higher HbA1c (8.8 (5.4) versus 8.0 (3.3)%), lower bicarbonate (22.6 (6.2) versus 24.8 (4.7) mmol/L), and higher anion gap (14.8 (6.1) versus 12.6 (4.2)) than had those with BHB < 1 mmol/L. There was no association between the presence of ketosis and the length of stay (4.2 (7.3) versus (3.0) (7.2) days). Acute illness in those with diabetes associated with ketosis in the absence of DKA is associated with worse glycaemic control than in those without ketosis. Ketosis may represent an intermediate state of metabolic dysregulation rather than being associated with a more severe acute illness, as suggested by no relationship between BHB and length of stay.

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Section: Discussionmentioning

confidence: 65%

The Significance of an Increased Beta-Hydroxybutyrate at Presentation to the Emergency Department in Patients with Diabetes in the Absence of a Hyperglycemic Emergency

Depczynski

Lee

Varndell

et al. 2019

Journal of Diabetes Research

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show abstract

“…Attempts were not made to achieve higher ketosis levels in our study. Fasting can influence the BOB levels and levels as high as 1mmol/l can be achieved during fasting and starvation [24] however this may not be a feasible and safe option in critical brain injuries. Maintenance of ketosis is essential to understand the beneficial effects of ketones.…”

Section: Discussionmentioning

confidence: 99%

“…The duration of KD ranged from 4 -14 days, with most patients receiving the therapy for at least 1 week. Four patients had elevated BOB levels before starting of KD which may be related to fasting [24]. KD was initiated within 8-33 hours (average 23 hours) of hospital admission.…”

Section: Outcomes After Kd Initiation (Primary Outcome)mentioning

confidence: 99%

Phase I single center trial of Ketogenic Diet for Adults with Traumatic Brain Injury

Arora

Litofsky

Golzy

et al. 2021

Preprint

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Background: Traumatic Brain injury (TBI) is a major cause of mortality and morbidity in the United States. Ketogenic diet (KD) has been shown to have neuroprotective effects in acute brain injury, but limited data about its use in adult TBI patients is available. The objective of this study is to investigate the feasibility and safety of ketogenic diet (KD) for adult TBI patients in the Neuroscience Intensive Care Unit (NSICU). Methods: TBI patients admitted to NSICU between June 2019 to March 2021 were enrolled in this single-center, open label, single-arm prospective intervention study. The primary feasibility outcome was achievement of ketosis (detection and maintenance of serum beta-hydroxybutyrate (BOB) levels above normal); secondary outcomes included laboratory and clinical adverse effects related to KD. Results: 10 adults with TBI with Abbreviated Injury Score (AIS)-Head of at least 3 and ventriculostomy tube inserted met inclusion/exclusion criteria and were considered for KD. Mean age was 47 years, and all patients were male. Eight out of 10 patients achieved ketosis within mean 2.2 days. KD was initiated within 8-33 hours (average 23 hours) of hospital admission. No clinical adverse effects were noted, 2 patients developed hypertriglyceridemia and 1 patient developed hypoglycemia. Serum glucose showed a decreasing trend in most patients. Conclusions: This pilot study shows that KD is feasible and safe in the management of TBI patients. A randomized controlled trial (RCT) is justified to further understand the optimal serum BOB levels, dose and duration of KD in TBI and its effect on the outcome.

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“…Over time, the body will acclimate to using ketone bodies as a primary fuel, which is called keto-adaptation, an element of fat-adaptation [ 30 , 31 , 32 ]. Glucose oxidation requires 11 steps to produce energy, whereas fat and ketone bodies can quickly provide energy in only three steps [ 33 , 34 ]. In any case, the capacity for the body to reserve ketone bodies and fat is much stronger.…”

Section: Introductionmentioning

confidence: 99%

Keto-Adaptation and Endurance Exercise Capacity, Fatigue Recovery, and Exercise-Induced Muscle and Organ Damage Prevention: A Narrative Review

2019

Sports

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A ketogenic diet (KD) could induce nutritional ketosis. Over time, the body will acclimate to use ketone bodies as a primary fuel to achieve keto-adaptation. Keto-adaptation may provide a consistent and fast energy supply, thus improving exercise performance and capacity. With its anti-inflammatory and anti-oxidative properties, a KD may contribute to muscle health, thus preventing exercise-induced fatigue and damage. Given the solid basis of its potential to improve exercise capacity, numerous investigations into KD and exercise have been carried out in recent years. This narrative review aims to summarize recent research about the potential of a KD as a nutritional approach during endurance exercise, focusing on endurance capacity, recovery from fatigue, and the prevention of exhaustive exercise-induced muscle and organ damage.

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Fasting Or Starving? Measurement of Blood Ketone Levels in 100 Fasted Elective and Emergency Adult Surgical Patients at An Australian Tertiary Hospital

Cited by 18 publications

References 14 publications

The Significance of an Increased Beta-Hydroxybutyrate at Presentation to the Emergency Department in Patients with Diabetes in the Absence of a Hyperglycemic Emergency

The Significance of an Increased Beta-Hydroxybutyrate at Presentation to the Emergency Department in Patients with Diabetes in the Absence of a Hyperglycemic Emergency

Phase I single center trial of Ketogenic Diet for Adults with Traumatic Brain Injury

Keto-Adaptation and Endurance Exercise Capacity, Fatigue Recovery, and Exercise-Induced Muscle and Organ Damage Prevention: A Narrative Review

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