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Anaesth Intensive Care. 2018 Sep;46(5):463-467.

Fasting or starving? Measurement of blood ketone levels in 100 fasted elective and emergency adult surgical patients at an Australian tertiary hospital.

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Faculty of Medicine and Health Sciences, University of Newcastle; Newcastle, New South Wales.


Prolonged fasting leads to a shift from carbohydrate to fat as the primary energy source, resulting in the production of ketones such as beta-hydroxybutyrate. Hyperketonaemia and ketoacidosis have been observed in young children fasting for surgery. The aim of this study was to investigate ketonaemia in adults fasted for surgery. One hundred non-diabetic adults presenting for elective or emergency surgery were assessed for the presence of hyperketonaemia (beta-hydroxybutyrate levels more than 1 mmol/l), and the relationship between beta-hydroxybutyrate, blood glucose and fasting duration was investigated. Three of 100 patients demonstrated hyperketonaemia, one of whom had ingested a ketogenic supplement the evening prior to surgery. No patient demonstrated beta-hydroxybutyrate levels suggestive of ketoacidosis (above 3 mmol/l). No relationship between fasting duration and ketone or glucose levels was observed. We found no evidence that prolonged preoperative fasting led to beta-hydroxybutyrate levels consistent with ketoacidosis.


acidosis, hypoglycaemia, child, adult, human; beta-hydroxybutyrate, insulin resistance, ketosis, starvation; fasting, blood glucose, 3-hydroxybutyric acid

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