It should be suspected in any patient who has a history of chronic alcohol dependency, malnutrition or recent episode of binge drinking [1]. Alcoholic ketoacidosis (AKA) is a condition seen commonly in patients with alcohol use disorder or after a bout of heavy drinking. It is a clinical diagnosis with patients presenting with tachycardia, tachypnea, dehydration, agitation, and abdominal pain. This activity illustrates the evaluation and treatment of alcoholic ketoacidosis and explains the role of the interprofessional team in managing patients with this condition.
What Are the Symptoms of Alcoholic Ketoacidosis?
If you have any additional complications during treatment, this will also affect the length of your hospital stay. When your body burns fat for energy, byproducts known as ketone bodies are produced. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream. This buildup of ketones can produce a life-threatening condition known as ketoacidosis. Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin.
- We present a 64-year-old female who presented with generalized abdominal pain, nausea, vomiting and shortness of breath.
- Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism.
- Given the increasing epidemic of alcohol-related healthcare admissions, this is an important condition to recognize and we aim to offer guidance on how to approach similar cases for the practising clinician.
- Subsequent mismanagement can lead to increasing morbidity and mortality for patients.
Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment
- The pathophysiology of alcoholic ketoacidosis is complex, involving the excessive production of ketones, which, along with dextrose administration, can impact blood pH levels.
- Patients are generally dehydrated, and serum glucose can be low, normal, or mildly elevated.
- If history does not rule out toxic alcohol ingestion as a cause of the elevated anion gap, serum methanol and ethylene glycol levels should be measured.
- Intravenous benzodiazepines can be administered based on the risk of seizures from impending alcohol withdrawal.
- The metabolism of alcohol itself is a probable contributor to the ketotic state.
The pathophysiology of alcoholic ketoacidosis is complex, involving the excessive production of ketones, which, along with dextrose administration, can impact 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. We present a 64-year-old female who presented with generalized abdominal pain, nausea, vomiting and shortness of breath. Arterial blood gas analysis showed significant acidaemia with a pH of 7.10, bicarbonate of 2.9 mmol/l and lactate of 11.7 mmol/l. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. Triglycerides stored in adipose tissue undergo lipolysis and are released into the circulation as free fatty acids bound ionically to albumin.
Alcoholic ketoacidosis: review of current practice and association of treatments to improvement
If the patient’s mental status is diminished, consider administration of naloxone and thiamine. With timely and aggressive intervention, the prognosis for a patient with AKA is good. The long-term prognosis for the patient is influenced more strongly by recovery from alcoholism. The prevalence of AKA in a given community correlates with the incidence and distribution of alcohol abuse in that community. Emergency clinician knowledge of the evaluation and management of AKA is essential in caring for these patients. This narrative review evaluates the pathogenesis, diagnosis, and management of AKA for emergency clinicians.
Patient Education
If you have existing liver disease in conjunction with AKA, the prognosis may be less favorable. The interplay of fatty acids, their metabolic pathways, and the precise mechanisms of ketone secretion contribute to the overall picture of alcoholic ketoacidosis. In some instances, doctors may also assess for lactic acidosis, a condition characterized by an excessive buildup of lactic acid in the bloodstream. Treatment approaches will depend on the specific diagnosis derived from these investigations, allowing healthcare providers to deliver tailored care. Your body typically produces ketone bodies when breaking down fat for energy, but their levels can rise significantly if you consume a lot of alcohol and don’t eat enough. (2) This can rapidly lead to AKA, which may manifest even after a single binge-drinking episode, especially if you abstain from eating for an extended period.
Signs and symptoms of alcoholic ketoacidosis
They will also ask about your health history and alcohol consumption. If your doctor suspects that you’ve developed this condition, they may order additional tests to rule out other possible conditions. After these test results are in, they can confirm the diagnosis. Several mechanisms are responsible for dehydration, including protracted vomiting, decreased fluid intake, and inhibition of antidiuretic hormone secretion by ethanol. Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels.
Prolonged vomiting leads to dehydration, which decreases renal perfusion, thereby limiting urinary excretion of ketoacids. Moreover, volume depletion increases the concentration of counter-regulatory hormones, further stimulating lipolysis and ketogenesis. Alcoholic ketoacidosis is attributed alcoholic ketoacidosis smell to the combined effects of alcohol and starvation on glucose metabolism. Laboratory analysis plays a major role in the evaluation of a patient with suspected alcoholic ketoacidosis. Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated.
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