Note information about the patient’s social situation and the presence of intoxicating agents besides alcohol. 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.
Ketogenesis
Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia. Alcoholic ketoacidosis is a recognised acute complication in alcohol dependent patients. Given the frequency with which the condition is seen in other countries, the possibility exists that many cases may be unrecognised and misdiagnosed in UK EDs.
Symptoms and Signs of Alcoholic Ketoacidosis
Specifically look for nystagmus, confusion, ataxia, confabulation, and restriction of extraocular movements. Strongly consider providing thiamine supplementation to patients with alcohol dependence even without signs of thiamine deficiency. Laboratory analysis plays a major role in the evaluation of a patient with suspected alcoholic ketoacidosis. Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated. People who drink large quantities of alcohol may not eat regularly.
Metabolic acidosis in the alcoholic: a pathophysiologic approach
In 1940, Dillon et al1 described a series of nine patients who had episodes of severe ketoacidosis in the absence of diabetes mellitus, all of whom had evidence of prolonged excessive alcohol consumption. It was not until 1970 that Jenkins et al2 described a further three non‐diabetic patients with a history of chronic heavy alcohol misuse and recurrent episodes of ketoacidosis. This group also proposed a possible underlying mechanism for this metabolic disturbance, naming it alcoholic ketoacidosis. If you have symptoms of alcoholic ketoacidosis, your doctor will perform a physical examination. They will also ask about your health history and alcohol consumption.
AKA should be included in the differential diagnosis of alcohol dependent patients presenting with acute illness. Management is based around exclusion of serious pathology and specific treatment for AKA where it is present. A possible link between AKA and sudden death in chronic alcoholism has been proposed but remains unconfirmed. Triglycerides stored in adipose tissue undergo lipolysis and are released into the circulation as free fatty acids bound ionically to albumin. Free fatty acids are removed by the liver, where they primarily undergo oxidation to hydroxybutyric acid and acetoacetate and subsequently are reesterified to triglyceride.
- Alcohol produces structural changes in human liver mitochondria within days.
- You should also follow all of your doctor’s recommendations to ensure proper nutrition and recovery.
- The accompanying lack of alcohol in the patient’s body and the fact that for some time, the only source of calories that a patient has is ethanol both contribute to the clinical syndrome that we see.
- Neurologically, patients are often agitated but may occasionally present lethargic on examination.
Lactic acidosis
Your prognosis will be impacted by the severity of your alcohol use and whether or not you have liver disease. Prolonged used of alcohol can result in cirrhosis, or permanent scarring of the liver. Cirrhosis of the liver can cause exhaustion, leg swelling, and nausea.
BOX 1 PRESENTING FEATURES OF AKA
The test is free, confidential, and no personal information is needed to receive the result. All alcoholic patients presenting with acute illness should be offered contact with addiction services prior to or following discharge wherever possible. Wrenn alcoholic ketoacidosis smell et al found altered mental status in 15% of patients, attributable in all but one case to hypoglycaemia, severe alcohol intoxication, or infection. Fever was seen in only two patients, both with other likely underlying causes.
The Journal of Emergency Medicine
Not eating enough or vomiting can lead to periods of starvation. 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. They provide some energy to your cells, but too much may cause your blood to become too acidic. This drop in blood sugar causes your body to decrease the amount of insulin it produces. Your cells need insulin to use the glucose in your blood for energy.
- Alcoholic ketoacidosis (AKA) is a condition seen commonly in patients with alcohol use disorder or after a bout of heavy drinking.
- Jenkins et al2 suggested that alcohol induced mitochondrial damage might account for AKA.
- 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.
- But it can happen after an episode of binge drinking in people who do not chronically abuse alcohol.
- Given the frequency with which the condition is seen in other countries, the possibility exists that many cases may be unrecognised and misdiagnosed in UK EDs.
Joining a local chapter of Alcoholics Anonymous may provide you with the support you need to cope. You should also follow all of your doctor’s recommendations to ensure proper nutrition and recovery. These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis. 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).