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. Restoration of volume status and correction of the acidosis may be difficult to accomplish in the emergency department (ED).
Differential diagnosis
Neurologically, patients are often agitated but may occasionally present lethargic on examination. Alcohol withdrawal, in combination with nausea and vomiting, makes most patients agitated. However, if an AKA patient is lethargic or comatose, an alternative cause should be sought. Attending regular doctor’s visits may also help keep you on track, although healthcare professionals are not readily accessible to all, underscoring the importance of knowing DKA symptoms. Symptoms develop quickly—usually over 24 hours—and range from nausea or vomiting to extreme fatigue and trouble thinking clearly. DKA is commonly triggered when you are under stress—like being sick—or when taking medications that change how your body handles glucose.
Who Is at Risk for Alcoholic Ketoacidosis?
In most cases, the patient’s endogenous insulin levels rise appropriately with adequate carbohydrate and volume replacement. If the patient’s blood glucose level is significantly elevated, AKA may be indistinguishable from diabetic ketoacidosis (DKA). Carbohydrate and fluid replacement reverse this process by increasing serum insulin levels and suppressing the release of glucagon and other counterregulatory hormones and by providing metabolic substrate. Dextrose stimulates the oxidation of the reduced form of nicotinamide adenine dinucleotide (NADH) and aids in normalizing the ratio of NADH to nicotinamide adenine dinucleotide (NAD+).
Medical Professionals
You can prevent alcoholic ketoacidosis by limiting your alcohol intake. You can learn how to reduce your alcohol intake or eliminate it altogether. 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. If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors. Seeking help as soon as symptoms arise reduces your chances of serious complications.
Inpatient Care
- The condition is further exacerbated by lipolysis, which releases free fatty acids into the bloodstream, and intravascular volume contraction.
- The metabolism of alcohol itself is a probable contributor to the ketotic state.
- If you have diabetes or you’re at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care.
Without enough insulin, the body begins to break down fat as fuel. If it’s left untreated, the buildup can lead to diabetic ketoacidosis. Since the majority of DKA cases occur in alcoholic ketoacidosis patients with a known history of diabetes, the condition is largely preventable via early detection. A requirement for any medications other than D5 NS and thiamine are uncommon.
Complications
Your doctor and other medical professionals will watch you for symptoms of withdrawal. Efficient and timely management can lead to enhanced patient outcomes in patients with AKA. However, after adequate treatment, it is equally essential to refer the patient to alcohol abuse rehabilitation programs to prevent recurrence and long-term irreversible damage from alcohol abuse.
What Are the Symptoms of Alcoholic Ketoacidosis?
- Growth hormone can enhance precursor fatty acid release and ketogenesis during insulin deficiency.
- It is a clinical diagnosis with patients presenting with tachycardia, tachypnea, dehydration, agitation, and abdominal pain.
- AKA can be an unrecognized cause of patients presenting with a severe metabolic acidosis, including the presence of ketones.
- Carbohydrate and fluid replacement reverse this process by increasing serum insulin levels and suppressing the release of glucagon and other counterregulatory hormones and by providing metabolic substrate.
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. The presence of a high anion gap, although not specific, is suggestive of AKA in a patient with an appropriate clinical history [9]. Additional measurements that may help determine the diagnosis of AKA include beta-hydroxybutyrate levels (high in AKA, low in DKA) and serum alcohol concentration (typically low or undetectable) [8]. 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. This is why diagnosis and subsequent treatment can sometimes be challenging, but it’s crucial to receive a proper and timely diagnosis to obtain the correct treatment.
Emergent Treatment of Alcoholic Ketoacidosis
Free fatty acids are either oxidized to CO2 or ketone bodies (acetoacetate, hydroxybutyrate, and acetone), or they are esterified to triacylglycerol and phospholipid. Carnitine acyltransferase (CAT) 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 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.
Risk factors
Healthcare professionals diagnose AKA through a combination of clinical evaluation and specific laboratory tests. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. DKA presents with a myriad of vague signs and symptoms like nausea, vomiting, and abdominal pain. People with DKA may also have increased thirst and urination, also called polyuria.
For patient education information, see the Mental Health and Behavior Center, as well as Alcoholism and Alcohol Intoxication. 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.