Alcoholic Ketoacidosis: Etiologies, Evaluation, and Management

Excessive alcohol consumption often causes malnourishment (not enough nutrients for the body to function well). Following resuscitation, our patient had plasma electrolyte levels corrected, nutritional supplementation provided and completed an alcohol detoxification regimen. Given the early recognition of AKA and concurrent management, our patient had a good outcome. She was discharged home and has been well on follow-up appointments. If you develop any of these symptoms, seek emergency medical attention.

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This ketoacidosis is similar to the ketoacidosis that occurs in diabetes except that, unlike in diabetic ketoacidosis, blood glucose levels are low. Alcoholic ketoacidosis (AKA) is a clinical syndrome seen mostly in patients with chronic alcohol use disorder and frequently seen in patients who binge drink. Typical patients are usually chronic drinkers who are unable to tolerate oral nutrition for a 1 to 3 day period. Patients often have a recent bout of heavy drinking before the period of relative starvation, with persistent vomiting and abdominal pain contributing to their inability to tolerate PO intake. AKA can be an unrecognized cause of patients presenting with a severe metabolic acidosis, including the presence of ketones.

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The low glucose stores combined with lack of food intake cause low blood glucose levels. Without insulin, most cells cannot get energy from the glucose that is in the blood. Cells still need energy to survive, so they switch to a back-up mechanism to obtain energy. Fat cells begin breaking down, producing compounds called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis).

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The key differential diagnosis to consider, and exclude, in these patients is DKA. Although DKA can also present with a severe metabolic acidosis, with a raised anion gap and the presence of ketones, the history and examination are quite distinct from that of someone presenting with AKA (Table 1). The main differential diagnoses for ketosis in our patient included AKA, starvation/fasting ketosis and DKA. In starvation ketosis, a mild ketosis is noted to develop in most after 12–24 h of fasting. Therefore, only a mild acidosis is observed in starvation ketosis. Patients typically present with non-specific features including nausea, vomiting and generalized abdominal pain.

Alcoholic Ketoacidosis Treatment and Diagnosis

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. 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.

Conditions

• Alcoholic ketoacidosis most commonly happens in people who have alcohol use disorder and chronically drink a lot of alcohol.
• Support groups can be a valuable source of support and can be combined with medication and therapy.
• The key principle of emergency management is adequate fluid resuscitation 10.
• AKA typically presents with a severe metabolic acidosis with a raised anion gap and electrolyte abnormalities, which are treatable if recognized early and appropriate management instituted.
• Prolonged used of alcohol can result in cirrhosis, or permanent scarring of the liver.
• Each of these situations increases the amount of acid in the system.

Each of these situations increases the amount of acid in the system. They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones. Subsequent fluid resuscitation and monitoring were instituted.

How is alcoholic ketoacidosis treated?

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

Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment

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. 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. 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.

In particular, cases of AKA can be misdiagnosed as diabetic ketoacidosis (DKA). Subsequent mismanagement can lead to increasing morbidity and mortality for patients. AKA typically presents with a severe metabolic acidosis with a raised anion gap and electrolyte abnormalities, which are treatable if recognized early and appropriate management instituted. 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. People who consume a lot of alcohol during one occasion often vomit repeatedly and stop eating. If the vomiting and starvation go on for a day or more, the liver’s normal stores of sugar (glucose) decrease.