Alcoholic Ketoacidosis: Practice Essentials, Pathophysiology, Etiology

Alcoholic ketoacidosis is the buildup of ketones in your blood caused by very heavy alcohol use. Alcoholic ketoacidosis can occur in adults of any age; alcoholic ketoacidosis more often occurs persons aged years who are chronic alcohol abusers. Rarely, alcoholic ketoacidosis occurs after a binge in persons who are not chronic drinkers 1. Ketones are a type of acid that form when the body breaks down fat for energy. Alcoholic ketoacidosis most often occurs in a malnourished person who drinks large amounts of alcohol every day.

In 1940, Dillon and colleagues first described alcoholic ketoacidosis as a distinct syndrome. AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels, and a normal or low glucose concentration. The diagnosis of AKA requires arterial blood gas measurement and serum chemistry assays. Alcoholic ketoacidosis is a condition that presents with a significant metabolic acidosis in patients with a history of alcohol excess.

Associated disease states

Excess alcohol intake, as demonstrated by recent binge by our patient, therefore can lead to a significant and severe metabolic acidosis. The patient received 4 liters of normal saline and was started on D5-1/2 NS prior to admission. He was alcoholic ketoacidosis given IV valium for alcohol withdrawal, and thiamine, folate, and phosphate were repleted. He was hospitalized for three days for management of AKA and alcohol withdrawal, then discharged once tolerating oral intake and in good condition.

The symptoms of alcoholic ketoacidosis vary based on how much alcohol the person consumes, as well as the number of ketones in their bloodstream. As mentioned previously, the more alcohol a person drinks in a short period, the more likely they are to experience this reaction. In 1971, David W. Jenkins and colleagues described cases of three non‐diabetic people 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. One complication of alcoholic ketoacidosis is alcohol withdrawal. Your doctor and other medical professionals will watch you for symptoms of withdrawal. Alcoholic ketoacidosis may lead to gastrointestinal bleeding.

Alcoholic Ketoacidosis Prevention

A degree of alcohol withdrawal and agitation are likely to present, resulting in an increased heart rate as well. 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. Subsequent fluid resuscitation and monitoring were instituted. Further biochemical investigation after treatment showed a rapid decline in the level of ketones and normalization of pH. Preventing alcoholic ketoacidosis mainly involves limiting or quitting drinking altogether. It most often occurs in a malnourishedperson who drinks large amounts of alcohol every day. Medically supervised detox is part of a general approach to addiction treatment called medically-assisted treatment .

Estimation of prevalence and outcomes of this population is limited by difficulty in diagnosing the condition and the presence of multiple disorders at presentation. 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. 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. Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions.

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