Alcoholic Ketoacidosis Endocrine and Metabolic Disorders MSD Manual Professional Edition

However, any long-term risks – such as its reoccurrence – depends on the person’s drinking habits. Subsequent fluid resuscitation and monitoring were instituted. Further biochemical investigation after treatment showed a rapid decline in the level of ketones and normalization of pH. Then change to 5% dextrose in half normal saline as maintenance until oral intake resumes.

Alcoholic ketoacidosis

This is a nice convenient source of glucose that you can use when you go long stretches without eating . If this pantry cannot provide enough glucose, you go to the store, spend some money , and make glucose. This process is called gluconeogenesis, which involves converting lactate to pyruvate which goes on to be converted to glucose.

Emergency Medicine Clinics of North America

In severe hypokalemia, potassium should be repleted prior to dextrose administration to avoid insulin-driven shift of potassium into cells. Diagnosis of AKA requires the detection of ketone bodies in the urine and serum.

  • Ethanol level are often low or negative despite a chronic alcohol use history.
  • With these tests, the doctor could find evidence of diabetes, which will require specialized treatment.
  • Severe derangements of potassium and/or magnesium may be implicated in the sudden deaths of some alcoholic patients, but not all.
  • The patient should have blood glucose checked on the initial presentation.

You can learn how to reduce your alcohol intake or eliminate it altogether. Joining a local chapter of Alcoholics Anonymous may provide you with the support you need to cope.

What are the symptoms of alcoholic ketoacidosis?

The pivotal variable appears to be a relative deficiency of insulin. Individuals with higher insulin levels are more likely to present with the syndrome of alcohol-induced hypoglycemia without ketoacidosis.

Alcoholic ketoacidosis

He denies a history of diabetes mellitus, ingestion of any toxic alcohols, or recent illness. An elevated anion gap metabolic acidosis and ketosis is the classic present. However, a mixed acid-base disorder may be present especially if vomiting is contributing to a hypochloremic alkalosis. The ketone which is present is mostly beta-hydroxybutyrate rather than acetoacetate resulting in only a weakly positive nitroprusside test. People usually do not present with high blood sugar or sugar in the urine. This can cause false negative results when testing urine ketones as they only measure acetoacetate.

Alcoholic ketoacidosis presenting as an acute abdomen

It is proposed that alcoholic ketoacidosis is a significant cause of death among people with chronic alcoholism although the true prevalence is unknown. Estimation of prevalence and outcomes of this population is limited by difficulty in diagnosing the condition and the presence of multiple disorders at presentation. The clinical and biochemical features of AKA are summarised in boxes 1 and 2. The classical presentation is of an alcoholic patient with abdominal pain and intractable vomiting following a significant period of increased alcohol intake and starvation. There may be a history of previous episodes requiring brief admissions with labels of “query pancreatitis” or “alcoholic gastritis”.

What are the symptoms of alcoholic ketoacidosis?

  • Nausea and vomiting.
  • Abdominal pain.
  • Agitation, confusion.
  • Changed level of alertness, which may lead to coma.
  • Fatigue, slow movements.
  • Deep, labored, rapid breathing.
  • Loss of appetite.
  • Symptoms of dehydration, such as dizziness, lightheadedness, and thirst.

This is a diagnosis that you can make in the ED with a good history and a few labs, and not only get the patient the treatment they need but avoid a treatment they sober houses in Boston don’t need – fomepizole. If you don’t think of AKA, the combination of labs can lead you down the path treating for ethylene glycol or methanol intoxication.