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Anorexia nervosa ketoacidosis symptoms

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What is Ketoacidosis, or ketosis? It is a metabolic state where the body has high concentrations of ketones (a type of water soluble molecule) in the blood serum and urine. When normal biological processes which regulate the amount of ketones in the body fail, this can result in a life-threatening condition called ketoacidosis. 

 sources cited
Last updated on 
November 4, 2022
In this article

There are several types of ketoacidosis: (1)

  1. Diabetic ketoacidosis: occurring in people who have type 1 or 2 diabetes mellitus.
  2. Alcoholic ketoacidosis.
  3. Starvation ketoacidosis: in this article, we will primarily discuss this type and as it relates to anorexia nervosa.

To better understand what happens in ketosis, it’s helpful to first understand how the body uses energy when not experiencing starvation. Food gets broken down into glucose, a sugar molecule which is the most important source of biochemical energy for the human body. Normally, small amounts of glucose circulate in the blood and are stored in the form of glycogen in cells throughout the body, especially in the liver.

In a person who is starving, after circulating glucose and glycogen stores are used up, their body will begin breaking down fatty acids, which produces ketones and results in ketosis. The body will eventually progress to breaking down protein molecules (including muscle and organ tissue) for energy. (1) 

This is what leads to muscle wasting (cachexia) which can occur in people with chronic anorexia nervosa. (1)

If starvation continues, ketosis can progress to starvation ketoacidosis. Ketoacidosis is a dangerous condition which can alter blood pH and requires medical attention. 

Symptoms of starvation ketoacidosis include: (1)

  • Dehydration
  • Vitamin and electrolyte deficiencies, such a sodium, magnesium, and phosphate
  • Fatigue
  • Fruity breath
  • Muscle cramps
  • Headache
  • Insomnia
  • Dry mouth
  • Sudden weakness
  • Shortness of breath

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How can I treat starvation ketoacidosis?

When the body is in starvation ketoacidosis and suddenly receives glucose again, insulin and many other hormones enter circulation to shift metabolism away from ketosis. This rapid secretion of insulin causes shifts of fluid and electrolytes in and out of various cells. The ensuing electrolyte imbalances can cause: (2)

  • Fluid overload
  • Arrhythmia
  • Seizures
  • Confusion (encephalopathy)
  • Death

For people who have been in prolonged states of starvation (including some individuals with anorexia nervosa) wishing to reintroduce food, it’s important to do this in a safe clinical setting, where providers can control how much glucose the body receives at one time and monitor electrolyte levels. 

Starvation ketoacidosis is a potentially fatal consequence of untreated AN. However, with appropriate treatment and nutritional support, starvation ketoacidosis can be reversed and recovery from eating disorders is possible. 

Speak to our specialists at Within Health to learn more about the thoughtful care our clinical care team provides. We offer virtual treatment programs for anyone with an eating disorder looking for professional support. Our team of dietitians, and nurses, will help make sure you are consuming the amount of food your body needs on a daily basis.

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Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.


  1. Ketoacidosis - StatPearls - NCBI Bookshelf. (n.d.). Retrieved May 9, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK534848/ 
  2. Runde, J., & Sentongo, T. (2019). Refeeding syndrome. Pediatric Annals, 48(11). https://doi.org/10.3928/19382359-20191017-02


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