It can also occur with people undergoing hunger strikes, fasting over 3 days, or people starving to death as the body is forced to break down fat for sustenance due to their lack of outside nutrition.

In diabetic patients, ketoacidosis is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Since insulin is required to absorb glucose from the blood, its deficiency results in an energy crisis, fatty acid metabolism, and production of ketone bodies. Hyperglycemia results in glucose overloading the nephron and spilling into the urine. Dehydration results following the osmotic movement of water into urine, exacerbating the acidosis.

In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.