Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia. Although AKA can cause a modest elevation in serum glucose, significant hyperglycaemia in patients with metabolic acidosis, the presence of ketones and a suggestive history would make DKA the more likely diagnosis. The clinical importance in recognizing AKA from DKA is demonstrated by cases of patients who were treated as DKA and developed severe hypoglycaemia as a result of inappropriate insulin administration [8]. The key differential diagnosis to consider, and exclude, in these patients is DKA.
What Are the Symptoms of Alcoholic Ketoacidosis?
The decreased insulin-to-glucagon ratio that occurs in starvation indirectly reduces the inhibition on CAT activity, thereby allowing more free fatty acids to undergo oxidation and ketone body formation. A person who isn’t eating properly and getting the nutrition the body needs from food because they’re drinking heavy amounts of alcohol instead, starts to get a buildup of excessive amounts of ketones in the body. The prognosis for alcoholic ketoacidosis is good as long as it’s treated early.
Clinical ReviewsAlcoholic Ketoacidosis: Etiologies, Evaluation, and Management
- She was discharged home and has been well on follow-up appointments.
- Under these same conditions, glucagon, catecholamine, and growth hormone secretion are all stimulated.
- Note information about the patient’s social situation and the presence of intoxicating agents besides alcohol.
- It also depends on how long it takes to get your body regulated and out of danger.
Acetyl coenzyme A is metabolized to the ketoacids, β-hydroxybutyrate (βHB) and acetoacetate. This case demonstrates the importance of considering AKA in the differential diagnosis of a patient presenting with non-specific symptoms, significant metabolic acidosis and a history of alcohol excess. It is essential to differentiate AKA from DKA to ensure that inappropriate insulin administration does not occur.
What are the symptoms of alcoholic ketoacidosis?
- The patient might be tachycardic, tachypneic, profoundly orthostatic, or frankly hypotensive as a result of dehydration from decreased oral intake, diaphoresis, and vomiting.
- When your body burns fat for energy, byproducts known as ketone bodies are produced.
- This is why diagnosis and subsequent treatment can sometimes be challenging, but it’s crucial to receive a proper and timely diagnosis to obtain the correct treatment.
- The main differential diagnoses for ketosis in our patient included AKA, starvation/fasting ketosis and DKA.
- People who consume a lot of alcohol during one occasion often vomit repeatedly and stop eating.
- Insulin may be required in patients with diabetes who have AKA.
Assess the patient’s airway and manage as clinically indicated. American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information. We strive to create content that is clear, concise, and easy to understand.
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- As rehydration progresses and adequate renal function is established, consider electrolyte replacement, giving particular attention to potassium and magnesium.
- The prognosis for alcoholic ketoacidosis is good as long as it’s treated early.
- Dehydration and volume constriction directly decrease the ability of the kidneys to excrete ketoacids.
- Alcoholic ketoacidosis doesn’t occur more often in any particular race or sex.
- This buildup of ketones can produce a life-threatening condition known as ketoacidosis.
- Profound dehydration can culminate in circulatory collapse and/or lactic acidosis.
If the patient’s mental status is diminished, consider administration of naloxone and thiamine. The typical history is an episode alcoholic ketoacidosis smell of heavy drinking followed … With timely and aggressive intervention, the prognosis for a patient with AKA is good.
Signs and symptoms of alcoholic ketoacidosis
This is a common presentation in the emergency department (ED) and requires targeted therapies. Patients typically present with non-specific features including nausea, vomiting and generalized abdominal pain. Vomiting and/or diarrhoea is common and can lead to hypovolaemia and potassium depletion. Signs of shock including tachycardia and hypotension can be complicated by overlap of alcohol withdrawal [2].
Pathogenetic mechanisms of hypomagnesemia in alcoholic patients
But it can happen after an episode of binge drinking in people who do not chronically abuse alcohol. Alcoholic ketoacidosis doesn’t occur more often in any particular race or sex. Triglycerides stored in adipose tissue undergo lipolysis and are released into the circulation as free fatty acids bound ionically to albumin.
Growth hormone can enhance precursor fatty acid release and ketogenesis during insulin deficiency. Catecholamines, particularly epinephrine, increase fatty acid release and enhance the rate of hepatic ketogenesis. In contrast to diabetic ketoacidosis, the predominant ketone body in AKA is β-OH.
