While most cases of ketoacidosis are diabetic, some are not. A number of other conditions can also cause metabolic acidosis with ketone bodies under certain circumstances.

Conditions associated with nondiabetic ketoacidosis:

(1) alcoholism

(2) sepsis or other severe infection

(3) starvation/fasting, including ketogenic diet

(4) pregnancy or lactation

(5) hyperthyroidism

(6) trauma or surgery

(7) drugs (alpelisib, salicylate, flumequine, gatifloxacin, dapagliflozin)


Many of the patients are found to have had reduced food intake (surgical fasting, binge drinking, etc.). The other common feature is an acute stress reaction.


Requirements for the diagnosis:

(1) evidence of metabolic acidosis with elevated ketone bodies

(2) exclusion of diabetes

(3) exclusion of euglycemic diabetic ketoacidosis

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