What Is Alcoholic Ketoacidosis? The Impact of a Buildup of Ketones in Your Blood

By: Countless Nutrition | August 13, 2021

AlcoholicsAnonymous.com does not endorse any treatment facility or guarantee the quality of care provided, or the results to be achieved, by any treatment facility. The information provided by AlcoholicsAnonymous.com is not a substitute for professional treatment advice. It should be noted that ketoacidosis is very rare9 and not a significant risk factor for AKA unless someone is also chronically abusing alcohol. 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 is an acute metabolic acidosis seen in persons with a recent history of binge drinking and little or no nutritional intake. The greatest threats to patients with alcoholic ketoacidosis are marked contraction in extracellular fluid volume , hypokalaemia, hypoglycaemia, and acidosis. Patients often become tachypneic due to acidosis, dehydration, alcohol withdrawal, and abdominal pain.

Ethanol metabolism

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 alcoholic ketoacidosis patient is lethargic or comatose, an alternative cause should be sought. Patients are often become tachypneic due to acidosis, dehydration, alcohol withdrawal and abdominal pain. Many of these symptoms can be dangerous, even fatal, so it’s important to seek medical attention right away if you suspect ketoacidosis. Sudden death due to alcoholic ketoacidosisis common among those who binge drink on an empty stomach or lose nutrients through vomiting. Excessive drinking damages the pancreas, impacting insulin production.

Potassium, phosphate, and magnesium are often low in patients with AKA and should be repleted along with glucose. The choice of oral vs. IV replacement depends on the severity of the abnormality and the ability of the patient to tolerate PO. NADH from the metabolism of ethanol to acetaldehyde drives the equilibrium between acetoacetic acid and beta-hydroxybutyric acid towards beta-hydroxybutyric acid. Acetoacetic acid is the acid detected by several diagnostic tests for AKA, like the nitroprusside test, so false negatives may result. In alcoholics, thiamine should be administered prior to any glucose-containing solutions. This will decrease the risk of precipitating Wernicke encephalopathy or Korsakoff syndrome 7. Limiting the amount of alcohol you drink may help prevent alcohol induced ketoacidosis.

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Patients develop acidosis, which causes an increase in respirations and fluid loss. The symptoms of alcoholic ketoacidosis vary based on how much alcohol the person consumes, as well as the number of ketones in their bloodstream.

Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder. Alcoholic ketoacidosis is characterized by high serum ketone levels and an elevated anion gap . A concomitant metabolic alkalosis is also common, alcoholic ketoacidosis resulting from vomiting and volume depletion. Although AKA most commonly occurs in adults with alcoholism, alcoholic ketoacidosis has been reported in less-experienced drinkers of all ages. Metabolic Panel – The basic metabolic panel will likely be abnormal.

Long-Term Effects of AKA

Thiamine supplementation is often included to prevent Wernicke encephalopathy. Alcoholic ketoacidosis is the buildup of ketones in the blood due to alcohol use. Acetaldehyde is then further oxidised in hepatic mitochondria to acetic acid, which then forms acetyl coenzyme A . This raised NADH/NAD ratio is thought to be pivotal in the development of ketoacidosis and lactic acidosis as described below. 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.

Onset is generally after a decreased ability to eat for a few days. Other conditions that may present similarly include other causes of high anion gap metabolic acidosis including diabetic ketoacidosis. Alcoholic ketoacidosis is also closely linked to malnutrition, which is a common problem among people who engage in chronic alcohol abuse.

Alcoholic ketoacidosis prognosis

Arterial blood gas and biochemistry studies reveal a raised anion gap metabolic acidosis without evidence of lactic or diabetic ketoacidosis. AKA is a common disorder in the emergency department, more common than previously thought. The acid-base abnormalities https://ecosoberhouse.com/ are more diverse than just a wide-gap metabolic acidosis and often include a concomitant metabolic alkalosis, hyperchloremic acidosis, or respiratory alkalosis. Semiquantitative serum acetoacetate levels were positive in 96% of patients.

• Alcoholic ketoacidosis is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids.
• 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.
• Patients should receive counseling on alcohol dependence, be encouraged to use multivitamins, and be offered treatment in an alcohol detoxification program.
• These agents are rarely used for the management of severe metabolic acidosis.
• Electrocardiogram – The EKG will likely show sinus tachycardia, but atrial fibrillation or atrial flutter can be seen in a dehydrated patient with chronic alcohol abuse disorder and alcoholic ketoacidosis.