What Is Alcoholic Ketoacidosis? The Impact of a Buildup of Ketones in Your Blood

The underlying pathophysiology is related to poor glycogen stores and elevated nicotinamide adenine dinucleotide and hydrogen. This results in metabolic acidosis with elevated beta-hydroxybutyrate levels. Patients with AKA most commonly present alcoholic ketoacidosis with a history of alcohol use (acute or chronic), poor oral intake, gastrointestinal symptoms, and ketoacidosis on laboratory assessment. Patients are generally dehydrated, and serum glucose can be low, normal, or mildly elevated.

Patient Education

Excessive alcohol consumption often causes malnourishment (not enough nutrients for the body to function well). Neurologically, patients are often agitated but may occasionally present lethargic on examination. Alcohol withdrawal, in combination with nausea and vomiting, makes most patients agitated. However, if an AKA patient is lethargic or comatose, an alternative cause should be sought. All chronic alcohol misusers attending the ED should receive intravenous B vitamins as recommended by The Royal College of Physicians.23 Strenuous efforts must be made to exclude concomitant pathology.

Clinical Bottom Line

Alcoholic ketoacidosis most commonly happens in people who have alcohol use disorder and chronically drink a lot of alcohol. 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.

Posterior Reversible Encephalopathy Syndrome: A Narrative Review for Emergency Clinicians

• This group also proposed a possible underlying mechanism for this metabolic disturbance, naming it alcoholic ketoacidosis.
• A possible link between AKA and sudden death in chronic alcoholism has been proposed but remains unconfirmed.
• 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.
• This buildup of ketones can produce a life-threatening condition known as ketoacidosis.

Support groups can be a valuable source of support and can be combined with medication and therapy.

• They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones.
• But it can happen after an episode of binge drinking in people who do not chronically abuse alcohol.
• This results in a decrease in circulating lactic acid and an increase in acetoacetate.
• Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels.
• They provide some energy to your cells, but too much may cause your blood to become too acidic.
• Pyruvate and lactate are then maintained in steady state at much higher levels than normal.

Ethanol metabolism

After these test results are in, they can confirm the diagnosis. Most cases of AKA occur when a person with poor nutritional status due to long-standing alcohol abuse who has been on a drinking binge suddenly decreases energy intake because of abdominal pain, nausea, or vomiting. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. Alcoholic ketoacidosis is usually triggered by an episode of heavy drinking. 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.

Ketone acidosis of nondiabetic adults

In contrast to diabetic ketoacidosis, the predominant ketone body in AKA is β-OH. Routine clinical assays for ketonemia test for AcAc and acetone but not for β-OH. Clinicians underestimate the degree of ketonemia if they rely solely on the results of laboratory testing. The absence of hyperglycemia makes diabetic ketoacidosis improbable. Patients with mild hyperglycemia may have underlying diabetes mellitus, which may be recognized by elevated levels of glycosylated hemoglobin (HbA1C). You can prevent alcoholic ketoacidosis by limiting your alcohol intake.

Alcoholic Ketoacidosis Symptoms

• This narrative review evaluates the pathogenesis, diagnosis, and management of AKA for emergency clinicians.
• People who consume a lot of alcohol during one occasion often vomit repeatedly and stop eating.
• Free fatty acids are removed by the liver, where they primarily undergo oxidation to hydroxybutyric acid and acetoacetate and subsequently are reesterified to triglyceride.
• Arterial blood gas and biochemistry studies reveal a raised anion gap metabolic acidosis without evidence of lactic or diabetic ketoacidosis.
• Group meetings provide support for people trying to quit drinking.

Alcoholic ketoacidosis is a problem caused by drinking a lot of alcohol without eating food. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. These agents are rarely used for the management https://ecosoberhouse.com/ of severe metabolic acidosis. Restoration of volume status and correction of the acidosis may be difficult to accomplish in the emergency department (ED). Evaluate the patient for signs of alcohol withdrawal syndrome, which may include tremors, agitation, diaphoresis, tachycardia, hypertension, seizures, or delirium.

Fluids alone do not correct AKA as quickly as fluids and carbohydrates together. Thiamine supplementation should also be given upon initiation of dextrose. Note information about the patient’s social situation and the presence of intoxicating agents besides alcohol.

Appropriately evaluate the patient for any life-threatening complications before a transfer is considered. 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.