Diabetic patients frequently encounter ketosis that is characterized by the breakdown of lipids with the consequent accumulation of ketone bodies. Several studies have demonstrated that reactive species are likely to induce tissue damage in diabetes, but the role of the ketone bodies in the process has not been fully investigated. In this study, electron paramagnetic resonance (EPR) spectroscopy combined with novel spin-trapping and immunological techniques has been used to investigate in vivo free radical formation in a murine model of acetone-induced ketosis. A six-line EPR spectrum consistent with the POBN radical adduct of a carbon-centered lipid-derived radical was detected in the liver extracts. To investigate the possible enzymatic source of these radicals, iNOS and NADPH oxidase knockout mice were used. Free radical production was unchanged in the NADPH oxidase knockout, but much decreased in the iNOS knockout mice, suggesting a role for iNOS in free radical production. Longer term exposure to acetone revealed iNOS overexpression in the liver together with protein radical formation, which was detected by confocal microscopy and a novel immuno-spin trapping method. Immunohistochemical analysis revealed enhanced lipid peroxidation, protein oxidation and tissue damage as a consequence of persistent free radical generation after 21 days of acetone treatment in control and NADPH oxidase knockout, but not in iNOS knockout mice. Taken together, our data demonstrate that acetone administration, a model of ketosis, can lead to a proinflammatory stage in the liver and, consequently, tissue damage through a free radical-dependent mechanism driven by iNOS overexpression.