Alcoholic ketoacidosis (AKA) is an acute metabolic acidosis seen in persons with a recent history of binge drinking and little or no nutritional intake. The pathophysiology of alcoholic ketoacidosis is complex, involving the excessive production of ketones, which, along with dextrose administration, can impact alcohol ketosis dangerous blood pH levels. The role of lactate, as well as the potential development of alkalosis or acid-base disturbances, is significant in understanding this condition. In some instances, doctors may also assess for lactic acidosis, a condition characterized by an excessive buildup of lactic acid in the bloodstream.
What Are the Symptoms of Alcoholic Ketoacidosis?
- The accompanying lack of alcohol in the patient’s body and the fact that for some time, the only source of calories that a patient has is ethanol both contribute to the clinical syndrome that we see.
- The patient’s recent nutritional intake, particularly a history of poor oral intake or fasting, is also considered, as AKA often occurs after a period of relative starvation.
- Alcoholic ketoacidosis (AKA) is an acute metabolic acidosis seen in persons with a recent history of binge drinking and little or no nutritional intake.
- However, if an AKA patient is lethargic or comatose, an alternative cause should be sought.
- In general, exogenous insulin is contraindicated in the treatment of AKA, because it may cause life-threatening hypoglycemia in patients with depleted glycogen stores.
Arrange follow-up to evaluate patients after the resolution of symptoms, in order to detect other complications of chronic alcohol abuse. Alcoholic ketoacidosis is a complication of alcohol use and starvation that causes excess acid in the bloodstream, resulting in vomiting and abdominal pain. Alcoholic ketoacidosis is the buildup of ketones in the blood due to alcohol use. Ketones are a type of acid that form when the body breaks down fat for energy. If you are diagnosed with alcoholic ketoacidosis, you’ll typically require hospitalization for close monitoring and specialized care.
Clinical Scenario
It is essential to administer thiamine before any glucose administration to avoid Wernicke’s encephalopathy preci[itation. If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized. Other electrolyte abnormalities concomitantly present with alcohol abuse and poor oral intake include hypomagnesemia and hypophosphatemia. Magnesium and phosphate levels should be measured and repleted if the serum levels are found low. During physical examination, healthcare professionals look for signs that are consistent with AKA, such as signs of dehydration and an alcoholic odor on the breath.
Management of Alcohol Withdrawal Syndrome
Restoration of volume status and correction of the acidosis may be difficult to accomplish in the emergency department (ED). Assess for clinical signs of thiamine deficiency (Wernicke-Korsakoff syndrome). Specifically look for nystagmus, confusion, ataxia, confabulation, and restriction of extraocular movements. Strongly consider providing thiamine supplementation to patients with alcohol dependence even without signs of thiamine deficiency. Upon discharge from the hospital, your doctor may recommend connecting you with resources and support to aid in your recovery from alcohol use disorder. This could include referrals to counseling, therapy, or rehabilitation programs, providing you with a structured path toward sustained sobriety.
What are the complications of alcoholic ketoacidosis?
These include acute pancreatitis, gastrointestinal bleeding, and alcohol withdrawal. Mortality specifically due to AKA has been linked to the severity of serum beta-hydroxybutyric acid in some studies. If you have symptoms of alcoholic ketoacidosis, your doctor will perform a physical examination. They will also ask about your health history and alcohol consumption.
A Patient With Alcoholic Ketoacidosis and Profound Lactemia
Going on a drinking binge when your body is in a malnourished state may cause abdominal pain, nausea, or vomiting. Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder. In general, the prognosis for a patient presenting with AKA is good as long as the condition is identified and treated early. The major cause of morbidity and mortality in patients diagnosed with AKA is under-recognition of concomitant diseases (that may have precipitated the AKA, to begin with).
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Contact The Recovery Village Palmer Lake if you have questions about treatment or if you’re ready to get on the path to recovery and end your addiction to alcohol. Patients generally do not need to be transferred to special facilities. Appropriately evaluate the patient for any life-threatening complications before a transfer is considered. Join 40,000+ People Who Receive Our Newsletter Get valuable resources on addiction, recovery, wellness, and our treatments delivered directly to your inbox. American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information.
- Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain.
- The interplay of fatty acids, their metabolic pathways, and the precise mechanisms of ketone secretion contribute to the overall picture of alcoholic ketoacidosis.
- Alcoholic ketoacidosis is usually triggered by an episode of heavy drinking.
- Restoration of volume status and correction of the acidosis may be difficult to accomplish in the emergency department (ED).
If you can’t eat for a day or more, your liver will use up its stored-up glucose, which is a type of sugar. When your liver uses up its stored glucose and you aren’t eating anything to provide more, your blood sugar levels will drop. The condition is further exacerbated by lipolysis, which releases free fatty acids into the bloodstream, and intravascular volume contraction. Additionally, it has been found that episodes of AKA are often triggered by a lack of oral nutrition over a period ranging from one to three days, particularly in individuals with a history of alcohol use disorder (AUD). This condition is characterized by the presence of high levels of ketones in the blood, which are acidic by-products of fat metabolism. Detection of acidosis may be complicated by concurrent metabolic alkalosis due to vomiting, resulting in a relatively normal pH; the main clue is the elevated anion gap.
Posterior Reversible Encephalopathy Syndrome: A Narrative Review for Emergency Clinicians
Conversely, when ketoacidosis is identified, but its origin is unrelated to alcohol, medical professionals may explore other diagnostic possibilities. This may involve conducting tests to rule out conditions such as starvation ketosis. If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors.
Treatment may involve fluids (salt and sugar solution) given through a vein. You may get vitamin supplements to treat malnutrition caused by excessive alcohol use. Chronic alcohol use may lead to ketoacidosis, but it can also have severe and far-reaching effects on your health and relationships that aren’t reversible. Alcoholic ketoacidosis is also commonly accompanied by the symptoms of dehydration, which include feeling thirsty, weak, dizzy, and lightheaded. If you were to ignore your symptoms, though, you could end up with a life-threatening condition like a heart attack or seizure, or a differential diagnosis. If you were to ignore your symptoms, though, you could end up with a life-threatening condition like a heart attack, seizure, Wernicke encephalopathy, or a differential diagnosis.
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