The patient may benefit from an alcohol rehabilitation program. Alcoholic ketoacidosis is a complication of alcohol use and starvation that causes excess acid in the bloodstream, resulting in vomiting and abdominal pain. One complication of alcoholic ketoacidosis is alcohol withdrawal. Your doctor and other medical professionals will watch you for symptoms of withdrawal. Alcoholic ketoacidosis may lead to gastrointestinal bleeding.

Emergency Department Care

Alcoholic ketoacidosis is a problem caused by drinking a lot of alcohol without eating food. 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.

McGraw Hill Medical

Fever was seen in only two patients, both with other likely underlying causes. 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. The resulting increase in the NADH/NAD+ ratio inhibits hepatic gluconeogenesis and elevates the ratio of hydroxybutyric acid to acetoacetic acid. Acetic acid (an acyl group carrier) is linked with coenzyme A (a thiol) to produce Acetyl-CoA. This process is catalyzed by the enzyme acetyl-CoA synthetase.

• Toxicity from methanol or ethylene glycol is an important differential diagnosis.
• Appropriately evaluate the patient for any life-threatening complications before a transfer is considered.
• Your cells need insulin to use the glucose in your blood for energy.
• If you have symptoms of alcoholic ketoacidosis, your doctor will perform a physical examination.

Clinical Features

Often, blood alcohol levels are no longer elevated when patients present with alcoholic ketoacidosis. Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia.

Treatment of Alcoholic Ketoacidosis

In general, exogenous insulin is contraindicated in the treatment of AKA, because it may cause life-threatening hypoglycemia in patients with depleted glycogen stores. In most cases, the patient’s endogenous insulin levels rise appropriately with adequate carbohydrate and volume replacement. Insulin may alcoholic ketoacidosis be required in patients with diabetes who have AKA. If the patient’s blood glucose level is significantly elevated, AKA may be indistinguishable from diabetic ketoacidosis (DKA). In general, the prognosis for a patient presenting with AKA is good as long as the condition is identified and treated early.

Management of Alcohol Withdrawal Syndrome