Fat cells begin breaking down, producing compounds called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). This ketoacidosis is similar to the ketoacidosis that occurs in diabetes except that, unlike in diabetic ketoacidosis, blood glucose levels are low. Ethanol metabolism results in NAD depletion manifesting as a higher ratio of the reduced form of nicotinamide adenine dinucleotide (NADH) to NAD.
How can I prevent alcoholic ketoacidosis?
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. It most often occurs in a malnourished person who drinks large amounts of alcohol every day. Assess for clinical signs of thiamine deficiency (Wernicke-Korsakoff syndrome). Specifically look for nystagmus, confusion, ataxia, confabulation, and restriction of extraocular movements.
- Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels.
- Prolonged vomiting leads to dehydration, which decreases renal perfusion, thereby limiting urinary excretion of ketoacids.
- People with this condition are usually admitted to the hospital, often to the intensive care unit (ICU).
- Assess the patient’s airway and manage as clinically indicated.
The syndrome of alcoholic ketoacidosis
The diagnosis is often delayed or missed, and this can have potentially fatal consequences. There are a variety of non-specific clinical manifestations that contribute to these diagnostic difficulties. In particular, cases of AKA can be misdiagnosed as diabetic ketoacidosis (DKA). Subsequent mismanagement can lead to increasing morbidity and mortality for patients. AKA typically presents with a severe metabolic acidosis with a raised anion gap and electrolyte abnormalities, which are treatable if recognized early and appropriate management instituted.
Why is this patient acutely altered?
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 alcoholic ketoacidosis smell is identified and treated early. The major cause of morbidity and mortality in patients diagnosed with AKA is under-recognition of concomitant diseases (that may have precipitated the AKA, to begin with).
Alcoholic Ketoacidosis Symptoms
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. 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. Prolonged vomiting leads to dehydration, which decreases renal perfusion, thereby limiting urinary excretion of ketoacids.
How Can Alcoholic Ketoacidosis Be Prevented?
Strongly consider providing thiamine supplementation to patients with alcohol dependence even without signs of thiamine deficiency. They provide some energy to your cells, but too much may cause your blood to become too acidic. 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.
Complicated Acidosis Presentations: When Is Diabetic Ketoacidosis Not Diabetic Ketoacidosis? A Case Series
- If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis.
- The key tenants to management of AKA include fluid resuscitation and electrolyte correction.
- Detection of acidosis may be complicated by concurrent metabolic alkalosis due to vomiting, resulting in a relatively normal pH; the main clue is the elevated anion gap.
- Restoration of volume status and correction of the acidosis may be difficult to accomplish in the emergency department (ED).