Figure 1. (a) The equilibrium of a redox reaction between isopropyl alcohol and acetone in dependency of NADH and NAD+ is shown. Isopropyl alcohol and acetone are both renally excreted and exhaled by the lungs. Adapted from Jones and Summers [6]. (b) In severe ketoacidosis concentrations of acetone and protons are highly elevated (indicated by increased size). In addition, NADH levels are high as well. The redox reaction predominantly takes place in a reversed manner leading to endogenous de novo reduction of acetone to isopropyl alcohol up to toxic concentrations. Acute kidney injury reduces renal clearance. Diaphragm dysfunction in DMD patients reduces pulmonal clearance. NADH: reduced nicotinamide adenine dinucleotide; DMD: Duchenne muscular dystrophy;