Lactic acidosis complicating treatment of ketosis of labour.

Hypertonic glucose, fructose, and sorbitol solutions were given intravenously to women in the first stage of labour who had ketonuria and ketonaemia as evidenced by a raised blood acetoacetate and 3-hydrosybutyrate. There was no difference in the antiketogenic action of these, which was rapid and effective, but when compared with a control group who were given normal saline they had a high incidence of hyperlactataemia, and nine out of 28 patients developed lactic acidosis after the infusions. The "lactatogenic" effect was shared by all three substrates, and when they are used in the treatment of ketosis of labour, and the mother develops lactic acidosis, they might exacerbate pre-existing lactic acidosis and precipitate fetal distress.     

Biochemical aspects of bovine ketosis

1. The concentrations of acetoacetate, β-hydroxybutyrate and metabolites related to gluconeogenesis were determined in biopsy samples of the livers of ketotic, normal lactating and normal non-lactating cows. Key enzymes of gluconeogenesis in the liver were also assayed. 2. Significant decreases were found in the ketotic liver in the concentrations of glucogenic amino acids (glutamate, glutamine, alanine) and of glucogenic oxo acids (α-oxoglutarate, pyruvate, oxaloacetate). 3. The β-hydroxybutyrate/acetoacetate concentration ratios were generally much higher than in rat liver. 4. The concentration of total fat was sevenfold higher in the ketotic liver, and that of glucose plus glycogen fourfold lower than in normal liver. 5. The blood of ketotic cows showed a marked rise in the concentration of free fatty acids. 6. The activities of pyruvate carboxylase, propionyl-CoA carboxylase, phosphopyruvate carboxylase and fructose 1,6-diphosphatase showed no clear-cut differences between normal and ketotic animals. 7. Glucose injection promptly relieved the ketotic condition with respect to both the clinical and biochemical signs. The fall in the concentrations of the ketone bodies in the blood was preceded by a fall in the concentrations of free fatty acids and glycerol. 8. The findings are taken to be consistent with the concept that an increased rate of gluconeogenesis, causing a decrease in the concentration of oxaloacetate, is a major causal factor in ketogenesis.     

Suppressive effect of vasopressin on ketosis in diabetic rats.

In order to clarify if vasopressin (VP) plays a role in the pathophysiology of hyperosmolar nonketotic diabetic coma (HNDC), VP has been infused to diabetic rats and plasma levels of glucose (PG), ketone bodies, FFA and glucagon were determined. High-dose VP infusion (1.2 U/kg/h) caused gradual elevation of PG (60%) and glucagon levels (600%), while ketone bodies showed transient decrease (20%) at 30 min. Under the suppression of endogenous glucagon secretion by constant infusion of somatostatin (100 micrograms/kg/h), high dose VP showed 25% increase in PG levels and 30% reduction of ketone body levels for the subsequent VP infusion for 1.5 hour. Low-dose VP infusion (0.06 U/kg/h) had no hyperglycemic effect, but suppressed ketosis (20%) in the same condition. There were no changes in plasma FFA concentrations, indicating no significant effect of VP on lipolysis. The results indicate that VP often elevated in HNDC may play an important role for the pathophysiology of HNDC through suppression of hepatic ketogenesis.     

Postexercise ketosis in night-migrating passerine birds

This study investigated the postexercise metabolism of six species of free-living, night-migrating passerine birds (European robin, pied flycatcher, wheatear, redstart, blackcap, and garden warbler). The birds were caught during autumn migration out of their nocturnal flight, and their metabolism changed from a fasting, highly active state to a fasting, resting state. Concentrations of six plasma metabolites of the fat, carbohydrate, and protein metabolism were measured during up to 10 h of recovery time. The metabolic changes indicated a biphasic pattern: (a) a quick first response to the reduced energy demands during the first 20 min of recovery, suggested by an increase and subsequent decrease of free fatty acid levels, and (b) subsequently, a postexercise ketosis and a reduction of lipolysis and proteolysis, suggested by high beta-hydroxy-butyrate and low free fatty acid, glycerol, triglyceride, and uric acid levels. This metabolic pattern differs from that of humans and rats, in which ketosis starts immediately postexercise or is absent in trained subjects. Since migrating birds are naturally adapted to endurance exercise, it is hypothesized that the high and long-lasting postexercise ketosis does not evoke physiological problems (such as hypoglycemia) but, by contrast, increases the ability of birds to rely on lipids, to a very high extent, during and after flight and decreases the dependence on glucose and glucogenic amino acids. Differences between species in fat stores and metabolic pattern support this hypothesis.     

Nicotinic acid reverses fasting ketosis by lowering the level of cyclic AMP.

When nicotinic acid was administered intraperitoneally to fasted rats, it reversed ketosis, decreased concentrations of cyclic AMP in adipose tissue and liver, and partially suppressed lipolysis. Administration of dibutyryl cyclic AMP reinduced ketosis in fasted rats previously treated with nicotinic acid. The results that nicotinic acid reverses ketosis by lowering tissue levels of cyclic AMP with a consequent suppression of lipolysis and ketogenesis.     

Upregulation of hepatic autophagy under nutritional ketosis

Many of the metabolic effects evoked by the ketogenic diet mimic the actions of fasting and the benefits of the ketogenic diet are often attributed to these similarities. Since fasting is a potent autophagy inductor in vivo and in vitro it has been hypothesized that the ketogenic diet may upregulate autophagy. The aim of the present study was to provide a comprehensive evaluation of the influence of the ketogenic diet on the hepatic autophagy. C57BL/6N male mice were fed with two different ketogenic chows composed of fat of either animal or plant origin for 4 weeks. To gain some insight into the time frame for the induction of autophagy on the ketogenic diet, we performed a short-term experiment in which animals were fed with ketogenic diets for only 24 or 48 h. The results showed that autophagy is upregulated in the livers of animals fed with the ketogenic diet. Moreover, the size of the observed effect was likely dependent on the diet composition. Subsequently, the markers of regulatory pathways that may link ketogenic diet action to autophagy were measured, i.e., the activity of mTORC1, activation of AMPK, and the levels of SIRT1, p53, and FOXO3. Overall, observed treatment-specific effects including the upregulation of SIRT1 and downregulation of FOXO3 and p53. Finally, a GC/MS analysis of the fatty acid composition of animals’ livers and the chows was performed in order to obtain an idea about the presence of specific compounds that may shape the effects of ketogenic diets on autophagy.     

Effects of somatostatin on established induced ketosis

The metabolic effects of Somatostatin (SRIF) added to insulin were studied in five diabetic subjects with ketonuria induced by insulin withdrawal. In the same patients ketonuria was induced twice and they were randomly treated with insulin alone (10 units as a bolus + infusion 1 U/hr) until euglycemia was reached or with insulin (same criteria) + cyclic SRIF (100 micrograms/ hr i.v.) for ten hours. Treatment with insulin + SRIF significantly reduced both peak and cumulative hGH levels in contrast to insulin alone. Moreover, the percent decrease of glucagon was significantly greater during insulin + SRIF than with insulin alone. On the other hand, the beta-OH levels fell significantly more during insulin + SRIF than during insulin alone. Finally the prolactin plasma levels fell considerably when combined treatment was given but not when just insulin was administered.