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remover). A rapid breakdown of fat, as may occur during strict low-carbohydrate diets and in uncontrolled diabetes mellitus, results in elevated levels of ketone bodies in the blood. This is a condition called ketosis. If there are sufficient amounts of ketone bodies in the blood to lower the blood pH, the condition is called ketoacidosis. Severe ketoacidosis, which may occur in diabetes mellitus, can lead to coma and death.

Clinical Investigation Clues

Remember that George had ketone bodies in his urine (ketonuria).

Why does George have ketonuria?

What benefit might he get from the rise in his blood ketone bodies?

C-OH

Acetoacetic Acetone acid

■ Figure 2.19 Ketone bodies. Acetoacetic acid, an acidic ketone body, can spontaneously decarboxylate (lose carbon dioxide) to form acetone. Acetone is a volatile ketone body that escapes in the exhaled breath, thereby lending a "fruity" smell to the breath of people with ketosis (elevated blood ketone bodies).

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