Alcoholic Ketoacidosis: Etiologies, Evaluation, and Management

Both steps require the reduction of nicotinamide adenine dinucleotide (NAD+) to reduced nicotinamide adenine dinucleotide (NADH). As a result, many people may not know they have type 1 diabetes. However, people with type 1 diabetes are unable to produce sufficient amounts of insulin. If someone has made their mind up to start a ketogenic diet, then they will need to cut carbohydrate intake to increase the production of ketones. However, there are some clear differences between ketosis and ketoacidosis.

alcoholic ketoacidosis

On arrival, he is tachycardic and tachypneic, and physical examination findings include dry mucous membranes, decreased sakin turgor, epigastric tenderness, and a tremor in both hands. Laboratory studies show a serum bicarbonate of 10 mEq/L, an anion gap of 30, a serum glucose of 95 mg/dL, a lactic acidosis with alcoholic ketoacidosis pH 7.2, hypophosphatemia, and trace ketonuria. He denies a history of diabetes mellitus, ingestion of any toxic alcohols, or recent illness. Lactic acidosis occurs when ethanol metabolism results in a high hepatic NADH/NAD ratio, diverting pyruvate metabolism towards lactate and inhibiting gluconeogenesis.


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. 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.

alcoholic ketoacidosis

Treatment for alcohol addiction is also necessary to prevent a relapse of alcoholic ketoacidosis. Alcoholic ketoacidosis is a problem caused by drinking a lot of alcohol without eating food. People with this condition are usually admitted to the hospital, often to the intensive care unit (ICU).

thoughts on “What Is Ketoacidosis and Do Ketogenic Diets Cause It?”

It also depends on how long it takes to get your body regulated and out of danger. If you have any additional complications during treatment, this will also affect the length of your hospital stay. If your blood glucose level is elevated, your doctor may also perform a hemoglobin A1C (HgA1C) test.

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. A 49-year-old male with a history of alcohol abuse presents to the ED with complaints of generalized abdominal pain and vomiting for the last 36 hours. The patient is well-known to the department for alcohol-related visits and continues to drink daily.

Alcoholic ketoacidosis

Other vitamins and minerals, such as magnesium, are added to the saline solution. If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help. In contrast to diabetic ketoacidosis, the predominant ketone body in AKA is β-OH.

  • Ketoacidosis occurs when the body digests something that gets turned into acid.
  • Both Wrenn et al6 and Fulop and Hoberman5 found evidence of alcoholic hepatitis to be common, with frequent elevations in serum transaminase activities and bilirubin.
  • The condition is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids.
  • The reversal of ketosis and vigorous rehydration are central in the management of AKA.
  • The pancreas produces insulin, and glucose comes from the foods you eat.

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. Nausea, vomiting, and abdominal pain were by far the most commonly observed complaints. Despite the frequency of abdominal symptoms, objective findings other than tenderness were infrequent.

First-time Diabetic Ketoacidosis in Type 2 Diabetics With Covid-19 Infection: A Novel Case Series

This literature review discusses the history, characterisation, pathophysiology, diagnosis, and management of AKA. Patients typically present with non-specific features including nausea, vomiting and generalized abdominal pain. Vomiting and/or diarrhoea is common and can lead to hypovolaemia and potassium depletion.

alcoholic ketoacidosis

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