Content
- Understanding Alcoholic Ketoacidosis
- Treatment of Alcoholic Ketoacidosis
- Ketoacidosis can Be alcohol in origin: A case report
- Symptoms
- EUH Morning Report: Alcoholic ketoacidosis (AKA): how does it present, what’s the pathophysiology, and how do you treat?
- MANAGEMENT
- Treatment of alcoholic acidosis: the role of dextrose and phosphorus.
Patients with alcohol use disorder require 100 mg of thiamine IV or IM prior to glucose to decrease the risk of precipitating Wernicke’s encephalopathy. Isotonic saline is given to correct fluid deficits from vomit and sodium and potassium losses in urine. Correction of fluid deficits helps to reduce secretion of catecholamines and glucagon to further slow ketogenesis. Therefore, only a mild acidosis is observed in starvation ketosis. AKA can occur in adults of any age; however, it most often develops in persons aged years who are chronic abusers of alcohol. Recently, a case report was published of an 11 year-old boy who presented in AKA after drinking ethanol-based mouthwash.
The ketone which is present is mostly beta-hydroxybutyrate rather than acetoacetate resulting in only a weakly positive nitroprusside test. People usually do not present with high blood sugar or sugar in the urine. This can cause false negative results when testing urine ketones as they only measure acetoacetate. Ethanol level are often low or negative despite a chronic alcohol use history. Electrolyte disturbances may include hypokalemia or hypomagnesemia may also be present.
Understanding Alcoholic Ketoacidosis
They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones. People with this condition are usually admitted to the hospital, often to the intensive care unit . The remainder of the patient’s laboratory evaluation – including liver enzymes, amylase, and lipase – were within normal limits, and methanol, ethylene glycol, salicylate, and digoxin levels were negative.
Why do ketones cause acidosis?
It typically occurs in the setting of hyperglycemia with relative or absolute insulin deficiency. The paucity of insulin causes unopposed lipolysis and oxidation of free fatty acids, resulting in ketone body production and subsequent increased anion gap metabolic acidosis.
During starvation, there is a decrease in insulin secretion and an increase in the production of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone. Hormone-sensitive lipase is normally inhibited by insulin, and, when insulin levels fall, lipolysis is up-regulated, causing release of free fatty acids from peripheral adipose tissue. Although AKA most commonly occurs in adults with alcoholism, it has been reported in less-experienced drinkers of all ages. Patients typically have a recent history of binge drinking, little or no food intake, and persistent vomiting.
Treatment of Alcoholic Ketoacidosis
Ethanol is metabolized by hepatocytes to acetic acid, which is converted to acetyl CoA. Acetyl CoA can be further oxidized through the Krebs cycle, used to synthesize fatty acids, or used in ketogenesis. The 2015 National Survey on Drug Use and Health stated that 15.1 million adults aged 18 years or older in the United States (equaling 6.2% of people in this age group) suffer from alcohol use disorder. The rate of US alcohol-related deaths is estimated to be 88,000 people per year. The metabolism of alcohol itself is a probable contributor to the ketotic state.
- Ethyl alcohol oxidizes at a rate of 20 to 25 mg/dL per hour in most individuals.
- Given the early recognition of AKA and concurrent management, our patient had a good outcome.
- Six cases of alcoholic and starvation ketoacidosis are described, the literature currently available is reviewed and the common pitfalls in managing such cases are discussed.
- In peripheral tissues, where NADH levels are lower, this lactate may be converted to pyruvate for metabolic needs.
- Toxicity from methanol or ethylene glycol is an important differential diagnosis.
If your blood glucose level is elevated, your doctor may also perform a hemoglobin A1C test. This test will provide information about your sugar levels to help determine whether you have diabetes. Alcoholic ketoacidosis is the buildup of ketones in the blood due to alcohol use. Ketones are alcoholic ketoacidosis a type of acid that form when the body breaks down fat for energy. Patients with alcohol use disorder commonly present to the ED critically ill, with myriad underlying pathologies. Alcoholic ketoacidosis should be considered in anyone with prolonged and/or binge consumption of alcohol.
Ketoacidosis can Be alcohol in origin: A case report
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 condition is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids.
