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id="toc-Biochemistry" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Biochemistry"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Biochemistry</span> </div> </a> <ul id="toc-Biochemistry-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Measurement" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Measurement"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Measurement</span> </div> </a> <button aria-controls="toc-Measurement-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Measurement subsection</span> </button> <ul id="toc-Measurement-sublist" class="vector-toc-list"> <li id="toc-Urine_testing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Urine_testing"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Urine testing</span> </div> </a> <ul id="toc-Urine_testing-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Serum_testing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Serum_testing"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Serum testing</span> </div> </a> <ul id="toc-Serum_testing-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Medical_uses" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Medical_uses"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Medical uses</span> </div> </a> <button aria-controls="toc-Medical_uses-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Medical uses subsection</span> </button> <ul id="toc-Medical_uses-sublist" class="vector-toc-list"> <li id="toc-Epilepsy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Epilepsy"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Epilepsy</span> </div> </a> <ul id="toc-Epilepsy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Obesity_and_metabolic_syndrome" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Obesity_and_metabolic_syndrome"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Obesity and metabolic syndrome</span> </div> </a> <ul id="toc-Obesity_and_metabolic_syndrome-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Safety" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Safety"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Safety</span> </div> </a> <button aria-controls="toc-Safety-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Safety subsection</span> </button> <ul id="toc-Safety-sublist" class="vector-toc-list"> <li id="toc-Medication_considerations" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication_considerations"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Medication considerations</span> </div> </a> <ul id="toc-Medication_considerations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Adverse_effects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Adverse_effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Adverse effects</span> </div> </a> <ul id="toc-Adverse_effects-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Contraindications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Contraindications"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>Contraindications</span> </div> </a> <ul id="toc-Contraindications-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Veterinary_medicine" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Veterinary_medicine"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Veterinary medicine</span> </div> </a> <ul id="toc-Veterinary_medicine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Ketosis</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 31 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-31" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">31 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%81%D8%B1%D8%B7_%D9%83%D9%8A%D8%AA%D9%88%D9%86_%D8%A7%D9%84%D8%AC%D8%B3%D9%85" title="فرط كيتون الجسم – Arabic" lang="ar" hreflang="ar" data-title="فرط كيتون الجسم" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Cetosi" title="Cetosi – Catalan" lang="ca" hreflang="ca" data-title="Cetosi" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Ket%C3%B3za" title="Ketóza – Czech" lang="cs" hreflang="cs" data-title="Ketóza" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Ketose_(Stoffwechsel)" title="Ketose (Stoffwechsel) – German" lang="de" hreflang="de" data-title="Ketose (Stoffwechsel)" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Ketoos" title="Ketoos – Estonian" lang="et" hreflang="et" data-title="Ketoos" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Cetosis" title="Cetosis – Spanish" lang="es" hreflang="es" data-title="Cetosis" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Zetosi" title="Zetosi – Basque" lang="eu" hreflang="eu" data-title="Zetosi" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%DA%A9%D8%AA%D9%88%D8%B2%DB%8C%D8%B3" title="کتوزیس – Persian" lang="fa" hreflang="fa" data-title="کتوزیس" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/C%C3%A9tose_(affection)" title="Cétose (affection) – French" lang="fr" hreflang="fr" data-title="Cétose (affection)" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%BC%80%ED%86%A4%EC%A6%9D" title="케톤증 – Korean" lang="ko" hreflang="ko" data-title="케톤증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Ketoza" title="Ketoza – Croatian" lang="hr" hreflang="hr" data-title="Ketoza" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/S%C3%BArdo%C3%B0i" title="Súrdoði – Icelandic" lang="is" hreflang="is" data-title="Súrdoði" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Chetosi" title="Chetosi – Italian" lang="it" hreflang="it" data-title="Chetosi" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A7%D7%99%D7%98%D7%95%D7%96%D7%99%D7%A1" title="קיטוזיס – Hebrew" lang="he" hreflang="he" data-title="קיטוזיס" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%9A%D0%B5%D1%82%D0%BE%D0%B7" title="Кетоз – Kyrgyz" lang="ky" hreflang="ky" data-title="Кетоз" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target"><span>Кыргызча</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Ketose_(metabolisme)" title="Ketose (metabolisme) – Dutch" lang="nl" hreflang="nl" data-title="Ketose (metabolisme)" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%82%B1%E3%83%88%E3%83%BC%E3%82%B7%E3%82%B9" title="ケトーシス – Japanese" lang="ja" hreflang="ja" data-title="ケトーシス" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Ketose" title="Ketose – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Ketose" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Ketose" title="Ketose – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Ketose" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Ketoza_(metabolizm)" title="Ketoza (metabolizm) – Polish" lang="pl" hreflang="pl" data-title="Ketoza (metabolizm)" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Cetose" title="Cetose – Portuguese" lang="pt" hreflang="pt" data-title="Cetose" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9A%D0%B5%D1%82%D0%BE%D0%B7" title="Кетоз – Russian" lang="ru" hreflang="ru" data-title="Кетоз" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Ketosis" title="Ketosis – Simple English" lang="en-simple" hreflang="en-simple" data-title="Ketosis" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Ket%C3%B3za_(metabolizmus)" title="Ketóza (metabolizmus) – Slovak" lang="sk" hreflang="sk" data-title="Ketóza (metabolizmus)" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Ketoza_(presnova)" title="Ketoza (presnova) – Slovenian" lang="sl" hreflang="sl" data-title="Ketoza (presnova)" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/Ketoza_(bolest)" title="Ketoza (bolest) – Serbian" lang="sr" hreflang="sr" data-title="Ketoza (bolest)" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Ketoza_(bolest)" title="Ketoza (bolest) – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Ketoza (bolest)" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Ketoosi_(tila)" title="Ketoosi (tila) – Finnish" lang="fi" hreflang="fi" data-title="Ketoosi (tila)" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Ketos_(metabolt_tillst%C3%A5nd)" title="Ketos (metabolt tillstånd) – Swedish" lang="sv" hreflang="sv" data-title="Ketos (metabolt tillstånd)" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Ketozis" title="Ketozis – Turkish" lang="tr" hreflang="tr" data-title="Ketozis" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E9%85%AE%E7%97%87" title="酮症 – Chinese" lang="zh" hreflang="zh" data-title="酮症" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span 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.infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Ketosis</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Ketonemia</td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span typeof="mw:File"><a href="/wiki/File:Ketone_bodies.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Ketone_bodies.png/120px-Ketone_bodies.png" decoding="async" width="120" height="227" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Ketone_bodies.png/180px-Ketone_bodies.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Ketone_bodies.png/240px-Ketone_bodies.png 2x" data-file-width="1287" data-file-height="2431" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Ketone_bodies" title="Ketone bodies">Ketone bodies</a>: acetone, acetoacetic acid, and beta-hydroxybutyric acid</td></tr><tr><th scope="row" class="infobox-label">Pronunciation</th><td class="infobox-data"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style><div class="plainlist"><ul><li><span class="rt-commentedText nowrap"><span class="IPA nopopups noexcerpt" lang="en-fonipa"><a href="/wiki/Help:IPA/English" title="Help:IPA/English">/<span style="border-bottom:1px dotted"><span title="'k' in 'kind'">k</span><span title="/ɪ/: 'i' in 'kit'">ɪ</span><span title="/ˈ/: primary stress follows">ˈ</span><span title="'t' in 'tie'">t</span><span title="/oʊ/: 'o' in 'code'">oʊ</span><span title="'s' in 'sigh'">s</span><span title="/ɪ/: 'i' in 'kit'">ɪ</span><span title="'s' in 'sigh'">s</span></span>/</a></span></span> </li></ul></div></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></td></tr></tbody></table> <p><b>Ketosis</b> is a metabolic state characterized by elevated levels of <a href="/wiki/Ketone_bodies" title="Ketone bodies">ketone bodies</a> in the blood or urine. Physiological ketosis is a normal response to low <a href="/wiki/Glucose" title="Glucose">glucose</a> availability. In physiological ketosis, ketones in the blood are elevated above baseline levels, but the body's <a href="/wiki/Acid%E2%80%93base_homeostasis" title="Acid–base homeostasis">acid–base homeostasis</a> is maintained. This contrasts with <a href="/wiki/Ketoacidosis" title="Ketoacidosis">ketoacidosis</a>, an uncontrolled production of ketones that occurs in pathologic states and causes a <a href="/wiki/Metabolic_acidosis" title="Metabolic acidosis">metabolic acidosis</a>, which is a medical emergency. Ketoacidosis is most commonly the result of complete <a href="/wiki/Insulin" title="Insulin">insulin</a> deficiency in <a href="/wiki/Type_1_diabetes" title="Type 1 diabetes">type 1 diabetes</a> or late-stage <a href="/wiki/Type_2_diabetes" title="Type 2 diabetes">type 2 diabetes</a>. Ketone levels can be measured in blood, urine or breath and are generally between 0.5 and 3.0 <a href="/wiki/Molar_concentration" title="Molar concentration">millimolar</a> (mM) in physiological ketosis, while ketoacidosis may cause blood concentrations greater than 10 mM.<sup id="cite_ref-:6_1-0" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Trace levels of ketones are always present in the blood and increase when blood glucose reserves are low and the <a href="/wiki/Liver" title="Liver">liver</a> shifts from primarily metabolizing carbohydrates to metabolizing fatty acids.<sup id="cite_ref-:4_2-0" class="reference"><a href="#cite_note-:4-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> This occurs during states of increased fatty acid oxidation such as fasting, starvation, carbohydrate restriction, or prolonged exercise. When the liver rapidly metabolizes <a href="/wiki/Fatty_acids" class="mw-redirect" title="Fatty acids">fatty acids</a> into <a href="/wiki/Acetyl-CoA" title="Acetyl-CoA">acetyl-CoA</a>, some acetyl-CoA molecules can then be converted into ketone bodies: <a href="/wiki/Pyruvate" class="mw-redirect" title="Pyruvate">pyruvate</a>, <a href="/wiki/Acetoacetate" class="mw-redirect" title="Acetoacetate">acetoacetate</a>, <a href="/wiki/Beta-hydroxybutyrate" class="mw-redirect" title="Beta-hydroxybutyrate">beta-hydroxybutyrate</a>, and <a href="/wiki/Acetone" title="Acetone">acetone</a>.<sup id="cite_ref-:6_1-1" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:4_2-1" class="reference"><a href="#cite_note-:4-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> These ketone bodies can function as an energy source as well as signalling molecules.<sup id="cite_ref-:12_3-0" class="reference"><a href="#cite_note-:12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The liver itself cannot utilize these molecules for energy, so the ketone bodies are released into the blood for use by peripheral tissues including the brain.<sup id="cite_ref-:4_2-2" class="reference"><a href="#cite_note-:4-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>When ketosis is induced by carbohydrate restriction, it is sometimes referred to as nutritional ketosis. A low-carbohydrate, moderate protein diet that can lead to ketosis is called a <a href="/wiki/Ketogenic_diet" title="Ketogenic diet">ketogenic diet</a>. Ketosis is well-established as a treatment for <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a> and is also effective in treating type 2 diabetes.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Definitions">Definitions</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=1" title="Edit section: Definitions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Normal serum levels of ketone bodies are less than 0.5 mM. <i>Hyperketonemia</i> is conventionally defined as levels in excess of 1 mM.<sup id="cite_ref-:6_1-2" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Physiological_ketosis">Physiological ketosis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=2" title="Edit section: Physiological ketosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Physiological ketosis is the non-pathological (normal functioning) elevation of ketone bodies that can result from any state of increased <a href="/wiki/Fatty_acid_oxidation" class="mw-redirect" title="Fatty acid oxidation">fatty acid oxidation</a> including fasting, prolonged exercise, or very low-carbohydrate diets such as the <a href="/wiki/Ketogenic_diet" title="Ketogenic diet">ketogenic diet</a>.<sup id="cite_ref-:5_5-0" class="reference"><a href="#cite_note-:5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> In physiological ketosis, serum ketone levels generally remain below 3 mM.<sup id="cite_ref-:6_1-3" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Ketoacidosis">Ketoacidosis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=3" title="Edit section: Ketoacidosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Ketoacidosis" title="Ketoacidosis">Ketoacidosis</a> is a pathological state of uncontrolled production of ketones that results in a <a href="/wiki/Metabolic_acidosis" title="Metabolic acidosis">metabolic acidosis</a>, with serum ketone levels typically in excess of 3 mM. Ketoacidosis is most commonly caused by a deficiency of insulin in type 1 diabetes or late stage type 2 diabetes but can also be the result of chronic heavy alcohol use, <a href="/wiki/Salicylate_poisoning" title="Salicylate poisoning">salicylate poisoning</a>, or isopropyl alcohol ingestion.<sup id="cite_ref-:6_1-4" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:4_2-3" class="reference"><a href="#cite_note-:4-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Ketoacidosis causes significant metabolic derangements and is a life-threatening medical emergency.<sup id="cite_ref-:4_2-4" class="reference"><a href="#cite_note-:4-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Ketoacidosis is distinct from physiological ketosis as it requires failure of the normal regulation of ketone body production.<sup id="cite_ref-:9_6-0" class="reference"><a href="#cite_note-:9-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:5_5-1" class="reference"><a href="#cite_note-:5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=4" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Elevated blood ketone levels are most often caused by accelerated ketone production but may also be caused by consumption of exogenous ketones or precursors. </p><p>When <a href="/wiki/Glycogen" title="Glycogen">glycogen</a> and blood glucose reserves are low, a metabolic shift occurs in order to save glucose for the brain which is unable to use <a href="/wiki/Fatty_acid" title="Fatty acid">fatty acids</a> for energy. This shift involves increasing fatty acid oxidation and production of ketones in the liver as an alternate energy source for the brain as well as the skeletal muscles, heart, and kidney.<sup id="cite_ref-:4_2-5" class="reference"><a href="#cite_note-:4-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:12_3-1" class="reference"><a href="#cite_note-:12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Low levels of ketones are always present in the blood and increase under circumstances of low glucose availability. For example, after an overnight fast, 2–6% of energy comes from ketones and this increases to 30–40% after a 3-day fast.<sup id="cite_ref-:6_1-5" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:4_2-6" class="reference"><a href="#cite_note-:4-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>The amount of carbohydrate restriction required to induce a state of ketosis is variable and depends on activity level, <a href="/wiki/Insulin_sensitivity" class="mw-redirect" title="Insulin sensitivity">insulin sensitivity</a>, genetics, age and other factors, but ketosis will usually occur when consuming less than 50 grams of carbohydrates per day for at least three days.<sup id="cite_ref-:7_7-0" class="reference"><a href="#cite_note-:7-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:13_8-0" class="reference"><a href="#cite_note-:13-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>Neonates, pregnant women and lactating women are populations that develop physiological ketosis especially rapidly in response to energetic challenges such as fasting or illness. This can progress to ketoacidosis in the setting of illness, although it occurs rarely. Propensity for ketone production in neonates is caused by their high-fat breast milk diet, disproportionately large central nervous system and limited liver glycogen.<sup id="cite_ref-:6_1-6" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Biochemistry">Biochemistry</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=5" title="Edit section: Biochemistry"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The precursors of ketone bodies include fatty acids from <a href="/wiki/Adipose_tissue" title="Adipose tissue">adipose tissue</a> or the diet and <a href="/wiki/Ketogenic_amino_acids" class="mw-redirect" title="Ketogenic amino acids">ketogenic amino acids</a>.<sup id="cite_ref-:0_10-0" class="reference"><a href="#cite_note-:0-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_11-0" class="reference"><a href="#cite_note-:1-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> The formation of ketone bodies occurs via <a href="/wiki/Ketogenesis" title="Ketogenesis">ketogenesis</a> in the <a href="/wiki/Mitochondrion" title="Mitochondrion">mitochondrial</a> matrix of liver cells. </p><p>Fatty acids can be released from adipose tissue by <a href="/wiki/Adipokine" title="Adipokine">adipokine</a> signaling of high <a href="/wiki/Glucagon" title="Glucagon">glucagon</a> and <a href="/wiki/Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> levels and low insulin levels. High glucagon and low insulin correspond to times of low glucose availability such as fasting.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Fatty acids bound to <a href="/wiki/Coenzyme_A" title="Coenzyme A">coenzyme A</a> allow penetration into mitochondria. Once inside the mitochondrion, the bound fatty acids are used as fuel in cells predominantly through <a href="/wiki/Beta_oxidation" title="Beta oxidation">beta oxidation</a>, which cleaves two carbons from the acyl-CoA molecule in every cycle to form <a href="/wiki/Acetyl-CoA" title="Acetyl-CoA">acetyl-CoA</a>. Acetyl-CoA enters the <a href="/wiki/Citric_acid_cycle" title="Citric acid cycle">citric acid cycle</a>, where it undergoes an <a href="/wiki/Aldol_condensation" title="Aldol condensation">aldol condensation</a> with <a href="/wiki/Oxaloacetic_acid" title="Oxaloacetic acid">oxaloacetate</a> to form <a href="/wiki/Citric_acid" title="Citric acid">citric acid</a>; citric acid then enters the <a href="/wiki/Tricarboxylic_acid_cycle" class="mw-redirect" title="Tricarboxylic acid cycle">tricarboxylic acid cycle</a> (TCA), which harvests a very high energy yield per carbon in the original fatty acid.<sup id="cite_ref-stryer32_13-0" class="reference"><a href="#cite_note-stryer32-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p> <figure class="mw-halign-right" typeof="mw:File/Frameless"><a href="/wiki/File:Ketones.svg" class="mw-file-description" title="Biochemical pathway of ketone synthesis in the liver and utilization by organs"><img alt="Biochemical pathway of ketone synthesis in the liver and utilization by organs" src="//upload.wikimedia.org/wikipedia/commons/thumb/7/79/Ketones.svg/420px-Ketones.svg.png" decoding="async" width="420" height="342" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/79/Ketones.svg/630px-Ketones.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/79/Ketones.svg/840px-Ketones.svg.png 2x" data-file-width="580" data-file-height="472" /></a><figcaption>Biochemical pathway of ketone synthesis in the liver and utilization by organs</figcaption></figure> <p>Acetyl-CoA can be metabolized through the TCA cycle in any cell, but it can also undergo ketogenesis in the mitochondria of liver cells.<sup id="cite_ref-:6_1-7" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> When glucose availability is low, oxaloacetate is diverted away from the TCA cycle and is instead used to produce glucose via <a href="/wiki/Gluconeogenesis" title="Gluconeogenesis">gluconeogenesis</a>. This utilization of oxaloacetate in gluconeogenesis can make it unavailable to condense with acetyl-CoA, preventing entrance into the TCA cycle. In this scenario, energy can be harvested from acetyl-CoA through ketone production. </p><p>In ketogenesis, two acetyl-CoA molecules condense to form <a href="/wiki/Acetoacetyl-CoA" title="Acetoacetyl-CoA">acetoacetyl-CoA</a> via <a href="/wiki/Thiolase" title="Thiolase">thiolase</a>. Acetoacetyl-CoA briefly combines with another acetyl-CoA via <a href="/wiki/Hydroxymethylglutaryl-CoA_synthase" title="Hydroxymethylglutaryl-CoA synthase">HMG-CoA synthase</a> to form <a href="/wiki/HMG-CoA" title="HMG-CoA">hydroxy-β-methylglutaryl-CoA</a>. Hydroxy-β-methylglutaryl-CoA form the ketone body acetoacetate via <a href="/wiki/3-hydroxy-3-methylglutaryl-CoA_lyase" class="mw-redirect" title="3-hydroxy-3-methylglutaryl-CoA lyase">HMG-CoA lyase</a>. Acetoacetate can then reversibly convert to another ketone body—<a href="/wiki/D-%CE%B2-hydroxybutyrate" class="mw-redirect" title="D-β-hydroxybutyrate">D-β-hydroxybutyrate</a>—via D-β-hydroxybutyrate dehydrogenase. Alternatively, acetoacetate can spontaneously degrade to a third ketone body (acetone) and <a href="/wiki/Carbon_dioxide" title="Carbon dioxide">carbon dioxide</a>, which generates much greater concentrations of acetoacetate and D-β-hydroxybutyrate. The resulting ketone bodies cannot be used for energy by the liver so are exported from the liver to supply energy to the brain and peripheral tissues. </p><p>In addition to fatty acids, deaminated <a href="/wiki/Ketogenic_amino_acids" class="mw-redirect" title="Ketogenic amino acids">ketogenic amino acids</a> can also be converted into intermediates in the citric acid cycle and produce ketone bodies.<sup id="cite_ref-:1_11-1" class="reference"><a href="#cite_note-:1-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Measurement">Measurement</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=6" title="Edit section: Measurement"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Ketone levels can be measured by testing urine, blood or breath. There are limitations in directly comparing these methods as they measure different ketone bodies. </p> <div class="mw-heading mw-heading3"><h3 id="Urine_testing">Urine testing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=7" title="Edit section: Urine testing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Ketonuria.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/1/18/Ketonuria.jpg/170px-Ketonuria.jpg" decoding="async" width="170" height="170" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/18/Ketonuria.jpg/255px-Ketonuria.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/18/Ketonuria.jpg/340px-Ketonuria.jpg 2x" data-file-width="1971" data-file-height="1971" /></a><figcaption>Test for ketonuria using Bayer Ketostix reagent strips</figcaption></figure> <p>Urine testing is the most common method of testing for ketones. Urine test strips utilize a <a href="/wiki/Nitroprusside" class="mw-redirect" title="Nitroprusside">nitroprusside</a> reaction with acetoacetate to give a semi-quantitative measure based on color change of the strip. Although beta-hydroxybutyrate is the predominant circulating ketone, urine test strips only measure acetoacetate. Urinary ketones often correlate poorly with serum levels because of variability in excretion of ketones by the kidney, influence of hydration status, and renal function.<sup id="cite_ref-:6_1-8" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:13_8-1" class="reference"><a href="#cite_note-:13-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Serum_testing">Serum testing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=8" title="Edit section: Serum testing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Finger-stick ketone meters allow instant testing of beta-hydroxybutyrate levels in the blood, similar to <a href="/wiki/Glucometers" class="mw-redirect" title="Glucometers">glucometers</a>. Beta-hydroxybutrate levels in blood can also be measured in a laboratory.<sup id="cite_ref-:6_1-9" class="reference"><a href="#cite_note-:6-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Medical_uses">Medical uses</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=9" title="Edit section: Medical uses"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Coatrack_section plainlinks metadata ambox ambox-style" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/40px-Edit-clear.svg.png" decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/60px-Edit-clear.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/80px-Edit-clear.svg.png 2x" data-file-width="48" data-file-height="48" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span"><b>This section may primarily relate to <a href="/wiki/Wikipedia:COATRACK" class="mw-redirect" title="Wikipedia:COATRACK">a different subject</a>, or place <a href="/wiki/Wikipedia:UNDUE" class="mw-redirect" title="Wikipedia:UNDUE">undue weight</a> on <a href="/wiki/Wikipedia:POVFORK" class="mw-redirect" title="Wikipedia:POVFORK">a particular aspect rather than the subject as a whole</a>.</b><span class="hide-when-compact"> Please help by <a href="/wiki/Wikipedia:Content_forks#Article_spinoffs:_.22Summary_style.22_meta-articles_and_summary_sections" title="Wikipedia:Content forks">spinning off</a> or <a href="/wiki/Wikipedia:Handling_trivia#Recommendations_for_handling_trivia" title="Wikipedia:Handling trivia">relocating</a> any relevant information, and removing <a href="/wiki/Wikipedia:What_Wikipedia_is_not#Wikipedia_is_not_an_indiscriminate_collection_of_information" title="Wikipedia:What Wikipedia is not">excessive detail</a> that may be against <a href="/wiki/Wikipedia:What_Wikipedia_is_not" title="Wikipedia:What Wikipedia is not">Wikipedia's inclusion policy</a>.</span> <span class="date-container"><i>(<span class="date">May 2020</span>)</i></span></div></td></tr></tbody></table> <div class="mw-heading mw-heading3"><h3 id="Epilepsy">Epilepsy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=10" title="Edit section: Epilepsy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Ketosis induced by a ketogenic diet is a long-accepted treatment for refractory <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a>.<sup id="cite_ref-Hartman2007_14-0" class="reference"><a href="#cite_note-Hartman2007-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Obesity_and_metabolic_syndrome">Obesity and metabolic syndrome</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=11" title="Edit section: Obesity and metabolic syndrome"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Ketosis can improve markers of <a href="/wiki/Metabolic_syndrome" title="Metabolic syndrome">metabolic syndrome</a> through reduction in serum <a href="/wiki/Triglyceride" title="Triglyceride">triglycerides</a>, elevation in <a href="/wiki/High-density_lipoprotein" title="High-density lipoprotein">high-density lipoprotein</a> (HDL) as well as increased size and volume of <a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">low-density lipoprotein</a> (LDL) particles. These changes are consistent with an improved lipid profile despite potential increases in <a href="/wiki/Cholesterol" title="Cholesterol">total cholesterol</a> level.<sup id="cite_ref-:7_7-1" class="reference"><a href="#cite_note-:7-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Gershuni_Yan_Medici_2018_15-0" class="reference"><a href="#cite_note-Gershuni_Yan_Medici_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Safety">Safety</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=12" title="Edit section: Safety"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The safety of ketosis from low-carbohydrate diets is often called into question by clinicians, researchers and the media.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Plaskett2003_18-0" class="reference"><a href="#cite_note-Plaskett2003-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> A common safety concern stems from the misunderstanding of the difference between physiological ketosis and pathologic ketoacidosis.<sup id="cite_ref-:9_6-1" class="reference"><a href="#cite_note-:9-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:7_7-2" class="reference"><a href="#cite_note-:7-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> There is also continued debate whether chronic ketosis is a healthy state or a stressor to be avoided. Some argue that humans evolved to avoid ketosis and should not be in ketosis long-term.<sup id="cite_ref-Plaskett2003_18-1" class="reference"><a href="#cite_note-Plaskett2003-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> The counter-argument is that there is no physiological requirement for dietary carbohydrate as adequate energy can be made via gluconeogenesis and ketogenesis indefinitely.<sup id="cite_ref-:8_19-0" class="reference"><a href="#cite_note-:8-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Alternatively, the switching between a ketotic and fed state has been proposed to have beneficial effects on metabolic and neurologic health.<sup id="cite_ref-:12_3-2" class="reference"><a href="#cite_note-:12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The effects of sustaining ketosis for up to two years are known from studies of people following a strict ketogenic diet for epilepsy or type 2 diabetes; these include short-term adverse effects leading to potential long-term ones.<sup id="cite_ref-:11_20-0" class="reference"><a href="#cite_note-:11-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> However, literature on longer term effects of intermittent ketosis is lacking.<sup id="cite_ref-:11_20-1" class="reference"><a href="#cite_note-:11-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medication_considerations">Medication considerations</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=13" title="Edit section: Medication considerations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Some medications require attention when in a state of ketosis, especially several classes of diabetes medication. <a href="/wiki/SGLT2_inhibitor" title="SGLT2 inhibitor">SGLT2 inhibitor</a> medications have been associated with cases of <a href="/wiki/Diabetic_ketoacidosis" title="Diabetic ketoacidosis">euglycemic ketoacidosis</a> – a rare state of high ketones causing a metabolic acidosis with normal blood glucose levels. This usually occurs with missed insulin doses, illness, dehydration or adherence to a low-carbohydrate diet while taking the medication.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Additionally, medications used to directly lower blood glucose including insulin and <a href="/wiki/Sulfonylurea" title="Sulfonylurea">sulfonylureas</a> may cause hypoglycemia if they are not titrated prior to starting a diet that results in ketosis.<sup id="cite_ref-:11_20-2" class="reference"><a href="#cite_note-:11-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Adverse_effects">Adverse effects</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=14" title="Edit section: Adverse effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There may be side effects when changing over from glucose metabolism to fat metabolism.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> These may include headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, constipation, and nausea, especially in the first days and weeks after starting a ketogenic diet.<sup id="cite_ref-:11_20-3" class="reference"><a href="#cite_note-:11-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Breath may develop a sweet, fruity flavor via production of acetone that is exhaled because of its high volatility.<sup id="cite_ref-:7_7-3" class="reference"><a href="#cite_note-:7-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Most adverse effects of long-term ketosis reported are in children because of its longstanding acceptance as a treatment for pediatric epilepsy. These include compromised bone health, stunted growth, <a href="/wiki/Hyperlipidemia" title="Hyperlipidemia">hyperlipidemia</a>, and <a href="/wiki/Kidney_stone_disease" title="Kidney stone disease">kidney stones</a>.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Contraindications">Contraindications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=15" title="Edit section: Contraindications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Ketosis induced by a ketogenic diet should not be pursued by people with <a href="/wiki/Pancreatitis" title="Pancreatitis">pancreatitis</a> because of the high dietary fat content. Ketosis is also contraindicated in <a href="/wiki/Pyruvate_carboxylase_deficiency" title="Pyruvate carboxylase deficiency">pyruvate carboxylase deficiency</a>, <a href="/wiki/Porphyria" title="Porphyria">porphyria</a>, and other rare <a href="/wiki/Inborn_errors_of_lipid_metabolism" class="mw-redirect" title="Inborn errors of lipid metabolism">genetic disorders of fat metabolism</a>.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Veterinary_medicine">Veterinary medicine</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=16" title="Edit section: Veterinary medicine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In <a href="/wiki/Dairy_cattle" title="Dairy cattle">dairy cattle</a>, ketosis commonly occurs during the first weeks after giving birth to a calf and is sometimes referred to as <i>acetonemia</i>. This is the result of an energy deficit when intake is inadequate to compensate for the increased metabolic demand of lactating. The elevated β-hydroxybutyrate concentrations can depress gluconeogenesis, feed intake and the immune system, as well as have an impact on milk composition.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Point of care diagnostic tests can be useful to screen for ketosis in cattle.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p><p>In <a href="/wiki/Sheep" title="Sheep">sheep</a>, ketosis, evidenced by hyperketonemia with <a href="/wiki/Beta-hydroxybutyrate" class="mw-redirect" title="Beta-hydroxybutyrate">beta-hydroxybutyrate</a> in blood over 0.7 mmol/L, is referred to as <i>pregnancy toxemia</i>.<sup id="cite_ref-Pugh2002_27-0" class="reference"><a href="#cite_note-Pugh2002-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Kimberling1988_28-0" class="reference"><a href="#cite_note-Kimberling1988-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> This may develop in late pregnancy in ewes bearing multiple fetuses and is associated with the considerable metabolic demands of the pregnancy.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> In ruminants, because most glucose in the digestive tract is metabolized by <a href="/wiki/Rumen" title="Rumen">rumen</a> organisms, glucose must be supplied by <a href="/wiki/Gluconeogenesis" title="Gluconeogenesis">gluconeogenesis</a>.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Pregnancy toxemia is most likely to occur in late pregnancy due to metabolic demand from rapid fetal growth and may be triggered by insufficient feed energy intake due to weather conditions, stress or other causes.<sup id="cite_ref-Kimberling1988_28-1" class="reference"><a href="#cite_note-Kimberling1988-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Prompt recovery may occur with natural parturition, Caesarean section or induced abortion. Prevention through appropriate feeding and other management is more effective than treatment of advanced stages of pregnancy toxemia.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=17" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/Bioenergetics" title="Bioenergetics">Bioenergetics</a></li> <li><a href="/wiki/Ketonuria" title="Ketonuria">Ketonuria</a></li> <li><a href="/wiki/Ketogenic_diet" title="Ketogenic diet">Ketogenic diet</a></li> <li><a href="/wiki/Very-low-calorie_diet" title="Very-low-calorie diet">Very-low-calorie diet</a></li> <li><a href="/wiki/Inuit_cuisine" title="Inuit cuisine">Inuit cuisine</a></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=18" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-:6-1"><span class="mw-cite-backlink">^ <a 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0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFLaffel1999" class="citation journal cs1">Laffel L (November 1999). <a rel="nofollow" class="external text" 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"A systematic review and meta-analysis of the diagnostic accuracy of point-of-care tests for the detection of hyperketonemia in dairy cows". <i>Preventive Veterinary Medicine</i>. <b>130</b>: 18–32. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.prevetmed.2016.06.002">10.1016/j.prevetmed.2016.06.002</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/27435643">27435643</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Preventive+Veterinary+Medicine&rft.atitle=A+systematic+review+and+meta-analysis+of+the+diagnostic+accuracy+of+point-of-care+tests+for+the+detection+of+hyperketonemia+in+dairy+cows&rft.volume=130&rft.pages=18-32&rft.date=2016&rft_id=info%3Adoi%2F10.1016%2Fj.prevetmed.2016.06.002&rft_id=info%3Apmid%2F27435643&rft.aulast=Tatone&rft.aufirst=EH&rft.au=Gordon%2C+JL&rft.au=Hubbs%2C+J&rft.au=LeBlanc%2C+SJ&rft.au=DeVries%2C+TJ&rft.au=Duffield%2C+TF&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKetosis" class="Z3988"></span></span> </li> <li id="cite_note-Pugh2002-27"><span class="mw-cite-backlink"><b><a href="#cite_ref-Pugh2002_27-0">^</a></b></span> <span class="reference-text">Pugh, D. G. 2002. Sheep and goat medicine. Saunders, Philadelphia. 468 pp.</span> </li> <li id="cite_note-Kimberling1988-28"><span class="mw-cite-backlink">^ <a href="#cite_ref-Kimberling1988_28-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Kimberling1988_28-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text">Kimberling, C. V. 1988. Jensen and Swift's diseases of sheep. 3rd Ed. Lea & Febiger, Philadelphia. 394 pp.</span> </li> <li id="cite_note-29"><span class="mw-cite-backlink"><b><a href="#cite_ref-29">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMarteniukHerdt1988" class="citation journal cs1">Marteniuk JV, Herdt TH (1988). "Pregnancy toxemia and ketosis of ewes and does". <i>The Veterinary Clinics of North America. Food Animal Practice</i>. <b>4</b> (2): 307–15. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fs0749-0720%2815%2931050-1">10.1016/s0749-0720(15)31050-1</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/3264753">3264753</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Veterinary+Clinics+of+North+America.+Food+Animal+Practice&rft.atitle=Pregnancy+toxemia+and+ketosis+of+ewes+and+does&rft.volume=4&rft.issue=2&rft.pages=307-15&rft.date=1988&rft_id=info%3Adoi%2F10.1016%2Fs0749-0720%2815%2931050-1&rft_id=info%3Apmid%2F3264753&rft.aulast=Marteniuk&rft.aufirst=JV&rft.au=Herdt%2C+TH&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKetosis" class="Z3988"></span></span> </li> <li id="cite_note-30"><span class="mw-cite-backlink"><b><a href="#cite_ref-30">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFReid1960" class="citation journal cs1">Reid RL (1960). 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Metabolic effects of glucose and glycerol in undernourished pregnant ewes and in ewes with pregnancy toxaemia". <i>Australian Journal of Agricultural Research</i>. <b>11</b>: 42–47. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1071%2Far9600042">10.1071/ar9600042</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Australian+Journal+of+Agricultural+Research&rft.atitle=Studies+on+the+carbohydrate+metabolism+of+sheep.+IX.+Metabolic+effects+of+glucose+and+glycerol+in+undernourished+pregnant+ewes+and+in+ewes+with+pregnancy+toxaemia&rft.volume=11&rft.pages=42-47&rft.date=1960&rft_id=info%3Adoi%2F10.1071%2Far9600042&rft.aulast=Reid&rft.aufirst=RL&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKetosis" class="Z3988"></span></span> </li> <li id="cite_note-31"><span class="mw-cite-backlink"><b><a href="#cite_ref-31">^</a></b></span> <span class="reference-text">Van Soest, P. J. 1994. Nutritional ecology of the ruminant. 2nd Ed. Cornell Univ. Press. 476 pp.</span> </li> <li id="cite_note-32"><span class="mw-cite-backlink"><b><a href="#cite_ref-32">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKahn2005" class="citation book cs1">Kahn CM, ed. (2005). <a href="/wiki/Merck_Veterinary_Manual" title="Merck Veterinary Manual"><i>Merck Veterinary Manual</i></a> (9th ed.). Whitehouse Station: <a href="/wiki/Merck_%26_Co." title="Merck & Co.">Merck & Co.</a></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Merck+Veterinary+Manual&rft.place=Whitehouse+Station&rft.edition=9th&rft.pub=Merck+%26+Co.&rft.date=2005&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKetosis" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=19" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLawrieLedward2014" class="citation book cs1">Lawrie RA, Ledward D (2014). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=b7xQAwAAQBAJ&pg=PA92"><i>Lawrie's Meat Science</i></a>. Elsevier Science. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-84569-161-5" title="Special:BookSources/978-1-84569-161-5"><bdi>978-1-84569-161-5</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Lawrie%27s+Meat+Science&rft.pub=Elsevier+Science&rft.date=2014&rft.isbn=978-1-84569-161-5&rft.aulast=Lawrie&rft.aufirst=R.+A.&rft.au=Ledward%2C+David&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Db7xQAwAAQBAJ%26pg%3DPA92&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKetosis" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFVolekPhinney2012" class="citation book cs1">Volek JS, Phinney SD (2012). <i>The Art and Science of Low Carbohydrate Performance</i>. Beyond Obesity. p. 91. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-9834907-1-5" title="Special:BookSources/978-0-9834907-1-5"><bdi>978-0-9834907-1-5</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Art+and+Science+of+Low+Carbohydrate+Performance&rft.pages=91&rft.pub=Beyond+Obesity&rft.date=2012&rft.isbn=978-0-9834907-1-5&rft.aulast=Volek&rft.aufirst=Jeff+S.&rft.au=Phinney%2C+Stephen+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKetosis" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLoweryWilson2017" class="citation book cs1">Lowery R, Wilson J (2017). <i>The Ketogenic Bible: The Authoritative Guide to Ketosis</i>. Victory Belt. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-62860-104-6" title="Special:BookSources/978-1-62860-104-6"><bdi>978-1-62860-104-6</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Ketogenic+Bible%3A+The+Authoritative+Guide+to+Ketosis&rft.pub=Victory+Belt&rft.date=2017&rft.isbn=978-1-62860-104-6&rft.aulast=Lowery&rft.aufirst=Ryan&rft.au=Wilson%2C+Jacob&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKetosis" class="Z3988"></span></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Ketosis&action=edit&section=20" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="navbox-styles"><style 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dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q1123139" class="extiw" title="d:Q1123139">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=276.2">276.2</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D007662">D007662</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb29485.htm">29485</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/2538008">2538008</a></li></ul></div></div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output .side-box-imageright{padding:2px 0.9em 2px 0;text-align:center}@media(min-width:500px){.mw-parser-output .side-box-flex{display:flex;align-items:center}.mw-parser-output .side-box-text{flex:1;min-width:0}}@media(min-width:720px){.mw-parser-output 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decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Wiktionary-logo-en-v2.svg/60px-Wiktionary-logo-en-v2.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/99/Wiktionary-logo-en-v2.svg/80px-Wiktionary-logo-en-v2.svg.png 2x" data-file-width="512" data-file-height="512" /></span></span></div> <div class="side-box-text plainlist">Look up <i><b><a href="https://en.wiktionary.org/wiki/Special:Search/ketosis" class="extiw" title="wiktionary:Special:Search/ketosis">ketosis</a></b></i> in Wiktionary, the free dictionary.</div></div> </div> <ul><li><i><a rel="nofollow" class="external text" href="http://www.emedicine.com/emerg/topic135.htm#">Diabetic Ketoacidosis</a></i> at <a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></li> <li><a rel="nofollow" class="external text" href="http://www.nhs.uk/conditions/ketosis/Pages/Introduction.aspx">NHS Direct: Ketosis</a></li> <li>The Merck Manual — <ul><li><a rel="nofollow" class="external text" href="http://www.merckmanuals.com/professional/sec13/ch169/ch169b.html">Diabetic Ketoacidosis</a></li> <li><a rel="nofollow" class="external text" href="http://www.merckmanuals.com/professional/sec13/ch169/ch169d.html">Alcoholic Ketoacidosis</a></li></ul></li></ul> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Metabolism,_catabolism,_anabolism" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Metabolism" title="Template:Metabolism"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Metabolism" title="Template talk:Metabolism"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Metabolism" title="Special:EditPage/Template:Metabolism"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Metabolism,_catabolism,_anabolism" style="font-size:114%;margin:0 4em"><a href="/wiki/Metabolism" title="Metabolism">Metabolism</a>, <a href="/wiki/Catabolism" title="Catabolism">catabolism</a>, <a href="/wiki/Anabolism" title="Anabolism">anabolism</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Metabolic_pathway" title="Metabolic pathway">Metabolic pathway</a></li> <li><a href="/wiki/Metabolic_network" title="Metabolic network">Metabolic network</a></li> <li><a href="/wiki/Primary_nutritional_groups" title="Primary nutritional groups">Primary nutritional groups</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bioenergetics" title="Bioenergetics">Energy<br /> metabolism</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aerobic_respiration" class="mw-redirect" title="Aerobic respiration">Aerobic respiration</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Glycolysis" title="Glycolysis">Glycolysis</a> → <a href="/wiki/Pyruvate_dehydrogenase" title="Pyruvate dehydrogenase">Pyruvate decarboxylation</a> → <a href="/wiki/Citric_acid_cycle" title="Citric acid cycle">Citric acid cycle</a> → <a href="/wiki/Oxidative_phosphorylation" title="Oxidative phosphorylation">Oxidative phosphorylation</a> (<span style="font-size:85%;"><a href="/wiki/Electron_transport_chain" title="Electron transport chain">electron transport chain</a> + <a href="/wiki/ATP_synthase" title="ATP synthase">ATP synthase</a></span>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Anaerobic_respiration" title="Anaerobic respiration">Anaerobic respiration</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Electron acceptors other than oxygen</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Fermentation" title="Fermentation">Fermentation</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Glycolysis" title="Glycolysis">Glycolysis</a> → <a href="/wiki/Substrate-level_phosphorylation" title="Substrate-level phosphorylation">Substrate-level phosphorylation</a> <ul><li><a href="/wiki/Acetone%E2%80%93butanol%E2%80%93ethanol_fermentation" title="Acetone–butanol–ethanol fermentation">ABE</a></li> <li><a href="/wiki/Ethanol_fermentation" title="Ethanol fermentation">Ethanol</a></li> <li><a href="/wiki/Lactic_acid_fermentation" title="Lactic acid fermentation">Lactic acid</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Specific<br /> paths</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Protein_metabolism" title="Protein metabolism">Protein metabolism</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Protein_biosynthesis" title="Protein biosynthesis">Protein synthesis</a></li> <li><a href="/wiki/Protein_catabolism" title="Protein catabolism">Catabolism</a> (protein→peptide→amino acid)</li></ul> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Amino_acid" title="Amino acid">Amino acid</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Amino_acid_synthesis" title="Amino acid synthesis">Amino acid synthesis</a></li> <li><a href="/wiki/Protein_catabolism#Amino_acid_degradation" title="Protein catabolism">Amino acid degradation</a> (amino acid→pyruvate, acetyl CoA, or TCA intermediate)</li> <li><a href="/wiki/Urea_cycle" title="Urea cycle">Urea cycle</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nucleic_acid_metabolism" title="Nucleic acid metabolism">Nucleotide<br /> metabolism</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Purine_metabolism" title="Purine metabolism">Purine metabolism</a></li> <li><a href="/wiki/Nucleotide_salvage" title="Nucleotide salvage">Nucleotide salvage</a></li> <li><a href="/wiki/Pyrimidine_metabolism" title="Pyrimidine metabolism">Pyrimidine metabolism</a></li> <li><a href="/wiki/Purine_nucleotide_cycle" title="Purine nucleotide cycle">Purine nucleotide cycle</a></li></ul> </div></td></tr></tbody></table><div> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Carbohydrate_metabolism" title="Carbohydrate metabolism">Carbohydrate metabolism</a><br />(<a href="/wiki/Carbohydrate_catabolism" title="Carbohydrate catabolism">carbohydrate catabolism</a><br />and <a href="/wiki/Anabolism" title="Anabolism">anabolism</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Human</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Glycolysis" title="Glycolysis">Glycolysis</a> ⇄ <a href="/wiki/Gluconeogenesis" title="Gluconeogenesis">Gluconeogenesis</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Glycogenolysis" title="Glycogenolysis">Glycogenolysis</a> ⇄ <a href="/wiki/Glycogenesis" title="Glycogenesis">Glycogenesis</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pentose_phosphate_pathway" title="Pentose phosphate pathway">Pentose phosphate pathway</a></li> <li><a href="/wiki/Fructolysis" title="Fructolysis">Fructolysis</a> <ul><li><a href="/wiki/Polyol_pathway" title="Polyol pathway">Polyol pathway</a></li></ul></li> <li><a href="/wiki/Galactolysis" title="Galactolysis">Galactolysis</a> <ul><li><a href="/wiki/Leloir_pathway" title="Leloir pathway">Leloir pathway</a></li></ul></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Glycosylation" title="Glycosylation">Glycosylation</a> <ul><li><a href="/wiki/N-linked_glycosylation" title="N-linked glycosylation">N-linked</a></li> <li><a href="/wiki/O-linked_glycosylation" title="O-linked glycosylation">O-linked</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Nonhuman</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Photosynthesis" title="Photosynthesis">Photosynthesis</a></li> <li><a href="/wiki/Anoxygenic_photosynthesis" title="Anoxygenic photosynthesis">Anoxygenic photosynthesis</a></li> <li><a href="/wiki/Chemosynthesis" title="Chemosynthesis">Chemosynthesis</a></li> <li><a href="/wiki/Carbon_fixation" class="mw-redirect" title="Carbon fixation">Carbon fixation</a></li> <li><a href="/w/index.php?title=DeLey-Doudoroff_pathway&action=edit&redlink=1" class="new" title="DeLey-Doudoroff pathway (page does not exist)">DeLey-Doudoroff pathway</a></li> <li><a href="/wiki/Entner-Doudoroff_pathway" class="mw-redirect" title="Entner-Doudoroff pathway">Entner-Doudoroff pathway</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Xylose_metabolism" title="Xylose metabolism">Xylose metabolism</a></li> <li><a href="/wiki/Radiotrophic_fungus" title="Radiotrophic fungus">Radiotrophism</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Lipid_metabolism" title="Lipid metabolism">Lipid metabolism</a> <br />(<a href="/wiki/Lipolysis" title="Lipolysis">lipolysis</a>, <a href="/wiki/Lipogenesis" title="Lipogenesis">lipogenesis</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Fatty_acid_metabolism" title="Fatty acid metabolism">Fatty acid metabolism</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Fatty_acid_degradation" title="Fatty acid degradation">Fatty acid degradation</a> (<a href="/wiki/Beta_oxidation" title="Beta oxidation">Beta oxidation</a>)</li> <li><a href="/wiki/Fatty_acid_synthesis" title="Fatty acid synthesis">Fatty acid synthesis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Steroid" title="Steroid">Steroid metabolism</a></li> <li><a href="/wiki/Sphingolipid_metabolism" class="mw-redirect" title="Sphingolipid metabolism">Sphingolipid metabolism</a></li> <li><a href="/wiki/Eicosanoid_metabolism" class="mw-redirect" title="Eicosanoid metabolism">Eicosanoid metabolism</a></li> <li><a class="mw-selflink selflink">Ketosis</a></li> <li><a href="/wiki/Reverse_cholesterol_transport" title="Reverse cholesterol transport">Reverse cholesterol transport</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bioinorganic_chemistry" title="Bioinorganic chemistry">Metal metabolism</a> <ul><li><a href="/wiki/Human_iron_metabolism" title="Human iron metabolism">Iron metabolism</a></li></ul></li> <li><a href="/wiki/Ethanol_metabolism" class="mw-redirect" title="Ethanol metabolism">Ethanol metabolism</a></li> <li><a href="/wiki/Phosphagen" title="Phosphagen">Phospagen system (ATP-PCr)</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" href="https://en.wikipedia.org/w/index.php?title=Ketosis&oldid=1254920204">https://en.wikipedia.org/w/index.php?title=Ketosis&oldid=1254920204</a>"</div></div> <div 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