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Starvation Ketosis and the Kidney
Biff F Palmer1, Deborah J Clegg2
1Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, El Paso, Texas, USA.
American Journal of Nephrology
|August 5, 2021
Summary
The body adapts to starvation by using keto acids for energy, conserving nitrogen and sparing muscle. Understanding these metabolic shifts is crucial for managing conditions like diabetic ketoacidosis.
Area of Science:
- Metabolic adaptation
- Human physiology
- Nutritional biochemistry
Background:
- The body's ability to adapt to long-term starvation was vital for early human survival.
- Understanding these adaptations offers clinical insights into ketoacidosis-related conditions.
Purpose of the Study:
- To explain the physiological mechanisms of adaptation to prolonged fasting.
- To highlight the clinical relevance of ketogenesis in various medical conditions.
Main Methods:
- Review of physiological and metabolic responses to starvation.
- Analysis of nitrogen and fuel substrate utilization during fasting.
- Examination of renal and acid-base adjustments.
Main Results:
- The brain shifts to utilizing keto acids, sparing glucose and reducing muscle protein breakdown.
- Nitrogen excretion changes from urea to ammonia, aiding in bicarbonate regeneration and waste excretion.
- Kidneys adapt to minimize nitrogen loss and conserve electrolytes, with sexual dimorphism observed.
Conclusions:
- Ketoacidosis is a key feature in conditions like diabetic ketoacidosis, alcoholic ketoacidosis, and SGLT2 inhibitor therapy.
- Familiarity with ketogenesis pathophysiology is essential for clinicians managing these metabolic states.
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