The first step is for an enzyme in your fat cells to break up stored triglycerides (the form of fat in adipose tissue). The enzyme action releases glycerol and fatty acids, which travel through your blood to body cells, where they combine with oxygen to produce heat/energy, plus water — lots of water — and the waste product carbon dioxide.
As anyone who has used a high-protein/high-fat/low-carb weight-loss diet such as the Atkins regimen can tell you, in addition to all that water, burning fat without glucose produces a second waste product called ketones. In extreme cases, high concentrations of ketones (a condition known as ketosis) alter the acid/alkaline balance (or pH) of your blood and may trip you into a coma. Left untreated, ketosis can lead to death. Medically, this condition is most common among people with diabetes. For people on a low-carb diet, the more likely sign of ketosis is stinky urine or breath that smells like acetone (nail polish remover)