Alcoholic ketoacidosis: a case report and review of the literature Oxford Medical Case Reports

Alcoholic ketoacidosis is a condition that presents with a significant metabolic acidosis in patients with a history of alcohol excess. The diagnosis is often delayed or missed, and this can have potentially fatal consequences.

A case series of 74 patients with AKA defined as a wide anion gap metabolic acidosis unexplained by any other disorder or toxin, including any patient with a history of chronic alcohol abuse. The setting was the Medical Emergency Department at Grady Memorial Hospital in Atlanta, Georgia, a university-affiliated inner-city hospital. Twenty-four chronic alcohol abusers hospitalized during a twenty-seven-month period were suspected of having “alcoholic ketoacidosis” because they had ketonuria or ketonemia with little or no glucosuria. Twenty-one had moderate or severe ketosis, with plasma 3-hydroxybutyrate of 5.2 to 22.5 mmol/L.

What Is the Prognosis for Alcoholic Ketoacidosis?

Under conditions of starvation, the liver increases the production of ketones from fatty acids to supply the brain, kidney, and other peripheral tissues with a metabolic fuel that can replace glucose. Increased ketogenesis secondary to the utilization of hepatic glycogen stores, with subsequently increased lipolysis and a decreased insulin-to-glucagon ratio, causes starvation ketosis. Alcoholic ketoacidosis is also closely linked to malnutrition, which is a common problem among people who engage in chronic alcohol abuse. When someone who is malnourished goes on an episode of binge drinking, abdominal pain, nausea, and vomiting can occur. Infection and other diseases such as pancreatitis can also cause alcoholic ketoacidosis in people with alcoholism. Therapy consists of both glucose administration and volume repletion (Table 226-3). Fluids alone do not correct the ketoacidosis as fast as fluids and glucose administered together.

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. Medically supervised detox is part alcoholic ketoacidosis of a general approach to addiction treatment called medically-assisted treatment . MAT is supported by the scientific community to successfully treat alcohol and other drug addiction and involve supervised detoxification, treatment planning, and counseling. The relationship of hypomagnesemia and alkalosis to alcohol withdrawal symptoms. Mechanism and significance of carbohydrate intolerance in chronic alcoholism.

Alcoholic hypoglycemia and ketosis [editorial]

And in AKA, acetylCoA levels are HIGH from all the fatty acid beta oxidation. There isn’t much pyruvate formation from glycolysis because the patient is not eating. Let’s look at this reaction that occurs in the cytoplasm in more detail. If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis. This can occur as soon as one day after a drinking binge, depending on nutritional status, overall health status, and the amount of alcohol consumed. If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help. For patient education information, see the Mental Health and Behavior Center, as well as Alcoholism and Alcohol Intoxication.

This finding can help to distinguish AKA from diabetic ketoacidosis . In 1971, David W. Jenkins and colleagues described cases of three non‐diabetic people with a history of chronic heavy alcohol misuse and recurrent episodes of ketoacidosis. Schelling J R, Howard R L, Winter S D.et al Increased osmolal gap in https://ecosoberhouse.com/ and lactic acidosis. 13.Iten PX, Meier M. Beta-hydroxybutyric acid--an indicator for an alcoholic ketoacidosis as cause of death in deceased alcohol abusers.

Chapter 226: Alcoholic Ketoacidosis

AKA is a common disorder in the emergency department, more common than previously thought. The acid-base abnormalities are more diverse than just a wide-gap metabolic acidosis and often include a concomitant metabolic alkalosis, hyperchloremic acidosis, or respiratory alkalosis. Semiquantitative serum acetoacetate levels were positive in 96% of patients.