Alcoholic Ketoacidosis: Causes, Symptoms, and Diagnosis

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This finding can help to distinguish AKA from diabetic ketoacidosis . When your body burns fat for energy, byproducts known as ketone bodies are produced. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream. This buildup of ketones can produce a life-threatening condition known as ketoacidosis. If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help. Treatment is generally with intravenous normal saline and intravenous sugar solution.

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. You can prevent alcoholic ketoacidosis by limiting your alcohol intake.

Metabolism of ethanol

The metabolism of alcohol itself is a probable contributor to the ketotic state. Alcohol dehydrogenase , a cytosolic enzyme, metabolizes alcohol to acetaldehyde in hepatocytes. Acetaldehyde is metabolized further to acetic acid by aldehyde dehydrogenase.

  • Mortality specifically due to AKA has been linked to the severity of serum beta-hydroxybutyric acid in some studies.
  • There was initial concern for acute liver failure until the patient’s hepatic function panel returned and argued against this diagnosis.
  • Patients with a complicated course, underlying illnesses, or persistent acidosis should be admitted for further evaluation and treatment (Table 226-3).

Details of osmolal gap are discussed in chapter 17, Fluids and Electrolytes. Excessive drinking can lead to frightening conditions like ketoacidosis. The risk of developing this condition is one of the reasons an alcohol use disorder is dangerous. Though alcoholic ketoacidosis can be reversible, it’s best to prevent it by limiting alcohol intake and never consuming alcohol on an empty stomach.

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Acetoacetic acid is the acid detected by several diagnostic tests for AKA, like the nitroprusside test, so false negatives may result. Alcohol ingestion, compounded with decreased caloric intake and dehydration, favors a ketotic state. 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. If they can’t use glucose because there’s not enough insulin, your body switches to another method to get energy — breaking down fat cells.

  • This will decrease the risk of precipitating Wernicke encephalopathy or Korsakoff syndrome.
  • The ketone which is present is mostly beta-hydroxybutyrate rather than acetoacetate resulting in only a weakly positive nitroprusside test.
  • If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis.
  • In alcoholics, thiamine should be administered prior to any glucose-containing solutions.
  • Alcoholic ketoacidosis is a frequently encountered metabolic disturbance that follows a prolonged intake of ethanol.
  • Ethanol metabolism results in NAD depletion manifesting as a higher ratio of the reduced form of nicotinamide adenine dinucleotide to NAD.

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