This typically occurs in diabetic patients with insulin deficiency. The lack of insulin leads to the inability to use glucose as main source of energy. Cells will then burn fat and protein for energy. The byproduct of this metabolism is ketones. Abnormally high blood concentrations of keto-acids will add H+ to the blood. ACIDOSIS or Diabetic ALKALOSIS Ketosis Effect on blood: [H+]. pH (circle one) Hypoxic conditions All cells produce lactic acid if they are deficient of oxygen through anaerobic respiration. If oxygen delivery to tissue is severely compromised, lactic acid production will be too high. Examples include cardiac arrest, MI, hypovolemic shock (e.g. massive fluid loss). The liver plays a major role in removing the small amount of lactic acid that is produced during normal cell metabolism, so that lactic acidosis can be a feature of liver failure. Excess lactic acid adds hydrogen ions to the blood. Prolong Hypoxia ACIDOSIS or ALKALOSIS (circle one) Effect on blood: [H+] pH