Alcoholic Ketoacidosis CCC Endocrine

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. Suspect alcoholic ketoacidosis in any patient with recent binge drinking and an elevated anion gap. A history of alcoholism is not necessary for the development of alcoholic ketoacidosis.

Does ketoacidosis ever go away?

Most people recover from treatment for diabetes-related ketoacidosis within a day. Sometimes it takes longer. If not treated soon enough, diabetes-related ketoacidosis can lead to severe complications including: Very low potassium levels (hypokalemia).

Once and electrolyte losses are replaced, change fluids to 5% dextrose in half normal saline until oral intake is assured.1 Patients with alcoholic ketoacidosis are not hyperosmolar. Unlike treatment of diabetic ketoacidosis, cerebral edema is of little concern with large volumes of fluid administration. Even with vigorous fluid resuscitation, in our review of the literature, cerebral edema has not been reported among those being treated for alcoholic ketoacidosis. Alcoholic ketoacidosis is also closely linked to malnutrition, which is a common problem among people who engage in chronic alcohol abuse. When someone who is malnourished goes on an episode of binge drinking, abdominal pain, nausea, and vomiting can occur. Infection and other diseases such as pancreatitis can also cause alcoholic ketoacidosis in people with alcoholism.

Alcoholic Ketoacidosis: Mind the Gap, Give Patients What They Need

This group also proposed a possible underlying mechanism for this metabolic disturbance, naming it alcoholic ketoacidosis. 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 most commonly happens in people who have alcohol use disorder and chronically drink a lot of alcohol.

What is fatal alcoholic ketoacidosis?

Alcoholic ketoacidosis (AKA) is a cause of severe metabolic acidosis usually occurring in malnourished patients with a history of recent alcoholic binge, often on a background of alcohol dependency. AKA can be fatal due to associated electrolyte abnormalities and subsequent development of cardiac arrhythmias.

They may be the reason that patients abruptly stop drinking, triggering ketoacidosis. Though these abdominal complaints are common, they are less commonly accompanied by signs such as abdominal distension, hypoactive bowel sounds, or rebound tenderness. The patient received 4 liters of normal saline and was started on D5-1/2 NS prior to admission. He was given IV valium for alcohol withdrawal, and thiamine, folate, and phosphate were repleted.

Diabetes Care

This buildup of ketones can produce a life-threatening condition known as ketoacidosis. 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. When your liver uses up its stored glucose and you aren’t eating anything to provide more, your blood sugar levels will drop.


The hallmark of AKA is ketoacidosis without marked hyperglycemia; the serum glucose level may be low, normal, or slightly elevated. This finding can help to distinguish AKA from diabetic ketoacidosis . These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis. Treatment is generally with intravenous normal saline and intravenous sugar solution. Thiamine and measures to prevent alcohol withdrawal are also recommended.

The syndrome of alcoholic ketoacidosis

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. Your doctor may also admit you to the intensive care unit if you require ongoing care.

Mortality is rare; however, alcoholic ketoacidosisic ketoacidosis has been reported as the cause of death in a number of alcoholics. Free fatty acids are either oxidized to CO2 or ketone bodies , or they are esterified to triacylglycerol and phospholipid. Carnitine acyltransferase transports free fatty acids into the mitochondria and therefore regulates their entry into the oxidative pathway. 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. If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis. This can occur as soon as one day after a drinking binge, depending on nutritional status, overall health status, and the amount of alcohol consumed.

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