The last decade has been characterized by exciting findings on eu- or
hypoglycemic ketosis and
ketoacidosis. This review emphasizes the following five key points: 1. Since the traditional
nitroprusside-
glycine dipstick test for urinary
ketones is often falsely negative, the blood determination of β-hydroxybutyrate, the predominant
ketone body, is currently advised for a comprehensive assessment of
ketone body status; 2. Fasting and
infections predispose to relevant
ketosis and
ketoacidosis especially in newborns, infants, children 7 years or less of age, and pregnant, parturient, or lactating women; 3. Several forms of
carbohydrate restriction (typically less than 20% of the daily caloric intake) are employed to induce
ketosis. These
ketogenic diets have achieved great interest as
antiepileptic treatment, in the management of excessive
body weight,
diabetes mellitus, and in sport training; 4. Intermittent fasting is more and more popular because it might benefit against
cardiovascular diseases,
cancers,
neurologic disorders, and aging; 5.
Gliflozins, a new group of oral
antidiabetics inhibiting the renal
sodium-glucose transporter 2, are an emerging cause of eu- or
hypoglycemic ketosis and
ketoacidosis. In conclusion, the role of
ketone bodies is increasingly recognized in several clinical conditions. In the context of acid-base balance evaluation, it is advisable to routinely integrate both the assessment of
lactic acid and β-hydroxybutyrate.