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.
Complications
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. Alcoholic ketoacidosis (AKA) is a common reason for investigation and admission of alcohol dependent patients in UK emergency departments. Although well described in international emergency medicine literature, UK emergency physicians rarely make the diagnosis of AKA. There is increasing evidence that rather than being benign and self limiting, AKA may be a significant cause of mortality in patients with alcohol dependence.
BOX 3 MANAGEMENT OF AKA
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).
Ketoacidosis associated with alcoholism in non-diabetic subjects
Intravenous benzodiazepines can be administered based on the risk of seizures from impending alcohol withdrawal. Antiemetics such as ondansetron or metoclopramide may also be given to control nausea and vomiting. Lactic acid levels are often elevated because of hypoperfusion and the altered balance of reduction and oxidation reactions in the liver.
- This results in a decrease in circulating lactic acid and an increase in acetoacetate.
- Appropriately evaluate the patient for any life-threatening complications before a transfer is considered.
- 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.
Deterrence and Patient Education
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.
Signs and symptoms of alcoholic ketoacidosis
Specifically look for nystagmus, confusion, ataxia, alcoholic ketoacidosis smell 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.
- 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.
- In the series from Fulop and Hoberman, seven patients were alkalaemic.
- If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors.
- Despite the frequency of abdominal symptoms, objective findings other than tenderness were infrequent.
- Assess for clinical signs of thiamine deficiency (Wernicke-Korsakoff syndrome).
This literature review discusses the history, characterisation, pathophysiology, diagnosis, and management of AKA. Most cases of AKA occur when a person with poor nutritional status due to long-standing alcohol abuse who has been on a drinking binge suddenly decreases energy intake because of abdominal pain, nausea, or vomiting. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. Alcoholic ketoacidosis is usually triggered by an episode of heavy drinking. If you can’t eat for a day or more, your liver will use up its stored-up glucose, which is a type of sugar.
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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 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.
Possible Complications of Alcoholic Ketoacidosis
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.
What Are the Symptoms of Alcoholic Ketoacidosis?
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.
