ketosis vs. ketoacidosis

We got let of class early today, right before the instructor was going to explain the physiology of DKA. Reviewing the book and online sources, I can't figure out what makes the difference between dietary ketosis and DKA. I understand the clinical findings, but why does the DKA patient fall into an extreme acidotic state? To see what I'm talking about, check out the clinical profiles.











ketosisketoacidosis
insulin↓↓
ketogenesis↑↑
ketonemia↑↑
ketonuria↑↑
pH-↓
Anion gap-↑
Lactic acidosis-↑
glucose↓↑
gluconeogenesis↑↑
glucosuria-↑

I dismiss the role of lactic acidosis since, as I understand it, lactic acidosis occurs as an effect rather than cause of DKA.

This leaves two possibilities: (1) relative increased ratio of production to utilization of ketones in DKA (either absolute ratio or ratio of rate); or (2) the pH change is wholly attributable to the dehydration caused by glucosuria in DKA.

I could make a story for either of these, but it's also possible there's some other contributing factor like kidney damage that I'm missing.

Anyone have any insights? Please reply.

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