Anorexia nervosa ketoacidosis symptoms

Anorexia nervosa (AN) is a serious mental health condition, but it can have just as many detrimental effects on someone's physical health.

Restricting caloric intake, participating in a low carb diet, and other eating habits frequently adopted by people struggling with AN can not only lead to dangerous weight loss, but ketoacidosis, a potentially life-threatening metabolic complication.

If you or a loved one are struggling with AN or another eating disorder, it's important to look out for the symptoms of ketoacidosis, and to seek help as soon as possible for this dangerous condition.

What is ketoacidosis?

Ketoacidosis is a condition that occurs when there are high levels of ketone bodies in the body's blood serum and urine.

Produced by the liver, ketone bodies are always present in the blood, with their production increasing during times of prolonged fasting and exercise. That's because these molecules represent an alternative source of energy for the body, which it generally taps into when glucose—the sugary byproduct of carbohydrates—is not available. (4)

But too many ketones can prove to be toxic. The molecules carry a more acidic pH, and a buildup of these fatty acids can dangerously alter the pH of the blood. (3)

When normal biological processes which regulate the amount of ketones in the body fail, this results in the potentially life-threatening condition called ketoacidosis.

Types of ketoacidosis

Ketoacidosis can be brought on by a number of different circumstances, so there are several different types of this condition, including: (1)

• Diabetic ketoacidosis: connected to the blood sugar and insulin irregularities involved with Type 1 or Type 2 diabetes
• Alcoholic ketoacidosis: brought on by the combination of heavy drinking and malnutrition
• Starvation ketoacidosis: triggered by extreme dietary restrictions, such as those seen with anorexia nervosa

As each condition has different causes, each may be treated differently, though any form of ketoacidosis is considered potentially life-threatening.

Ketoacidosis vs. ketosis

Ketoacidosis is often confused with ketosis, and while the two states share some traits, there are a few important differences.

The focus of the ketogenic diet, ketosis describes a point at which the body's metabolic state shifts, and it will burn fat for energy, as opposed to carbohydrates.

Even mild ketosis can encourage higher levels of ketones in the blood, so it's important for people following this possibly dangerous diet trend to follow up regularly with their physician.

Still, when followed thoughtfully, the keto diet is generally considered safe, if not controversial among nutritionists and dietitians. (3)

Ketoacidosis and anorexia nervosa

As anorexia nervosa and many other eating disorders often manifest through intermittent fasting, a low carbohydrate diet, and other extreme dietary restrictions, people with these conditions are most likely to experience starvation ketoacidosis.

To better understand how starvation ketoacidosis develops, it’s helpful to first understand how the body uses energy when not in this extreme metabolic state.

In healthy individuals, 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.

Healthy people generally have enough glucose in their blood to power their bodies. But when a person is starving, their body uses up any circulating glucose and glycogen stores. It will then begin breaking down stored fat in an attempt to continue generating energy. This breaks down fatty acids and frees up more ketones, which circulate freely through the blood and can eventually alter blood pH. (1)

The process can happen quickly, with the body turning to fatty acids for fuel after only two or three days of fasting. After that point, it will progress to breaking down protein molecules, including muscle and organ tissue, for energy, which is what leads to muscle wasting, or cachexia, in many people with AN. (1)

Anorexia ketosis symptoms

Ketoacidosis is a dangerous condition which requires medical attention to properly treat. 

When brought on by starvation, malnutrition, and other forms of disordered eating, ketoacidosis can be detected through symptoms such as: (1)

• Dehydration
• Deficiencies in vitamins and electrolytes, including sodium, magnesium, and phosphate
• Fatigue
• Fruity breath
• Muscle cramps
• Headache
• Insomnia
• Dry mouth
• Sudden weakness
• Shortness of breath

These symptoms may not necessarily mean someone is struggling with ketoacidosis, but they often point to some type of deeper problem, especially when experienced chronically.

Ketoacidosis and refeeding syndrome

While ketoacidosis is a dangerous condition, treatment for it must be carefully managed.

When the body is in a state of starvation ketoacidosis, it is utilizing an entirely different metabolic process. In this state, the sudden introduction of food can cause a spike in insulin and many other hormones, as the body attempts to capture that new source of fuel.

But this dramatic shift can lead to dangerous electrolyte abnormalities, which can bring on severe symptoms, such as: (2)

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

All told, these symptoms are called refeeding syndrome. And their severity is what makes it so important that someone with ketoacidosis, or even someone with chronic anorexia nervosa, has their conditions treated by medical professionals.

How to treat starvation ketoacidosis

For people who have been in prolonged states of starvation, it's important to reintroduce food in a safe, clinical setting. This often involves staying in a hospital or treatment facility until glucose, insulin, and other key vitamins, minerals, and electrolytes are back to safe levels.

Providers in these cases can control how much glucose the body receives at one time and monitor electrolyte levels and other vital signs to ensure the patient is not in danger of the more extreme consequences of refeeding syndrome. Often, this is done, at first, with an IV drip, before slowly introducing the patient to a wider variety of nourishment. 

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 the eating disorder driving it is possible. 

Finding help for anorexia nervosa

Anorexia nervosa is a dangerous and potentially deadly condition. But it doesn't have to be destiny. There are many different types of therapy that can offer help.

Speaking to our specialists at Within Health, you can learn more about the best treatment options for you, and the thoughtful care our clinical care team provides.

But regardless of where you decide to seek out treatment, the most important thing you can do is make the decision to seek it out. Anorexia nervosa can seem like an impossible dragon to slay, but with the help of a caring and thoughtful treatment team, it is possible to overcome the condition, and start on the road to a healthier and happier future.