If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help. Alcoholic ketoacidosis (AKA) is defined by metabolic acidosis and ketosis in a patient with alcohol use. This is a common presentation in the emergency department (ED) and requires targeted therapies. Alcoholic ketoacidosis is a condition that can happen when you’ve had a lot of alcohol and haven’t had much to eat or have been vomiting. When this happens, it can cause ketones, which are acids, to build up in your blood. If not treated quickly, alcoholic ketoacidosis may be life-threatening.
- 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.
- Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels.
- It should be used as an indicator of the severity of the disease.[13] Identifying these high-risk patients can help set the intensity of monitoring required for the patient to ensure optimal patient outcomes are achieved.
- If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized.
- 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.
- How severe the alcohol use is, and the presence of liver disease or other problems, may also affect the outlook.
When to Contact a Medical Professional
If indicated, provide follow-up with AKA patients to assess the problem of alcohol abuse. Elevated cortisol levels can increase fatty acid mobilization and ketogenesis. Growth hormone can enhance precursor fatty acid release and ketogenesis during insulin deficiency.
Signs and symptoms of alcoholic ketoacidosis
Thiamine supplementation should also be given upon initiation of dextrose. The metabolism of alcohol itself is a probable contributor to the ketotic state. Alcohol dehydrogenase (ADH), a cytosolic enzyme, metabolizes alcohol to acetaldehyde in hepatocytes. Acetaldehyde is metabolized further to acetic acid by aldehyde dehydrogenase. Both steps require the reduction of nicotinamide adenine dinucleotide (NAD+) to reduced nicotinamide adenine dinucleotide (NADH). Emergency clinician knowledge of the evaluation and management of AKA is essential in caring for these patients.
Understanding the Internal Symptoms of Alcoholic Ketoacidosis
Patients with mild hyperglycemia may have underlying diabetes mellitus, which may be recognized by elevated levels of glycosylated hemoglobin (HbA1C). Efficient and timely management can lead to enhanced patient outcomes in patients with AKA. However, after adequate treatment, it is equally essential to refer the patient to alcohol abuse rehabilitation programs to prevent recurrence and long-term irreversible damage from alcohol abuse.
Patients with AKA require prompt medical attention to address the underlying metabolic disturbances and prevent further complications. The presence of a high anion gap, although not specific, is suggestive of AKA in a patient with an appropriate clinical history [9]. Additional measurements that may help determine the diagnosis of AKA include beta-hydroxybutyrate levels (high in AKA, low in DKA) and serum alcohol concentration (typically low or undetectable) [8]. The key principle of emergency management is adequate fluid resuscitation [10]. Increasing volume status and providing increased perfusion to tissues help reduce lactic acid, ketoacids and acetic acid, which would all have been contributing to the severe acidosis. 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.
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. 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. 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. In normal metabolism, ketogenesis generates ketone bodies as an alternative energy source, especially for the brain and heart when glucose is scarce.
Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis
The key tenants to management of AKA include fluid resuscitation and electrolyte correction. AKA can be an unrecognized cause of patients presenting with a severe metabolic acidosis, alcoholic ketoacidosis smell including the presence of ketones. It should be suspected in any patient who has a history of chronic alcohol dependency, malnutrition or recent episode of binge drinking [1].
Patient Education
Individuals with AKA may experience a range of internal symptoms that profoundly affect their well-being. Central to these symptoms is a feeling of deep, labored, and rapid breathing as the body attempts to correct the blood’s acidity, a condition referred to as Kussmaul respiration. We present a 64-year-old female who presented with generalized abdominal pain, nausea, vomiting and shortness of breath.
