On the mammalian acetone metabolism: from chemistry to clinical implications.

In recent decades, two facts have changed the opinion of researchers about the function of acetone in humans. Firstly, it has turned out that acetone cannot be regarded as simply a waste product of metabolism, because there are several pathways in which acetone is produced or broken down. Secondly, methods have emerged making possible its detection in exhaled breath, thereby offering an attractive alternative to investigation of blood and urine samples. From a clinical point of view the measurement of breath acetone levels is important, but there are limitations to its wide application. These limitations can be divided into two classes, technical and biological limits. The technical limits include the storage of samples, detection threshold, standardization of clinical settings, and the price of instruments. When considering the biological ranges of acetone, personal factors such as race, age, gender, weight, food consumption, medication, illicit drugs, and even profession/class have to be taken into account to use concentration information for disorders. In some diseases such as diabetes mellitus and lung cancer, as well as in nutrition-related behavior such as starvation and ketogenic diet, breath acetone has been extensively examined. At the same time, there is a lack of investigations in other cases in which ketosis is also evident, such as in alcoholism or an inborn error of metabolism. In summary, the detection of acetone in exhaled breath is a useful and promising tool for diagnosis and it can be used as a marker to follow the effectiveness of treatments in some disorders. However, further endeavors are needed for clarification of the exact distribution of acetone in different body compartments and evaluation of its complex role in humans, especially in those cases in which a ketotic state also occurs.

https://iopscience.iop.org/article/10.1088/1752-7163/aa66d3/pdf

Breath acetone as a potential marker in clinical practice.

Determination of volatile substances in biological samples by headspace gas chromatography

Rapid determination of acetone in human plasma by gas chromatography–mass spectrometry and solid-phase microextraction with on-fiber derivatization

Determination of ketone bodies in postmortem blood by head-space gas chromatography

A method is described on gas chromatographic headspace analysis for the determination of the physiological ketone bodies: acetone, acetoacetate and beta-hydroxybutyrate. The procedure proposed involves quantitative conversion of both acetoacetate by decarboxylation in a strong acidic medium, and beta-hydroxybutyrate by oxidation to acetoacetate and decarboxylation to acetone, which is then quantified chromatographically. The successful application of the method is illustrated by the values of ketone bodies in plasma, kidney, lung, and liver of fed and 48-hr-fasted rats.

J M Argilés

Papers

Simultaneous determination of ketone bodies in biological samples by gas chromatographic headspace analysis.