Blog
Alcoholic Ketoacidosis: Etiologies, Evaluation, and Management
Written by VictoriaDenison
Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder. Alcoholic ketoacidosis is a recognised acute complication in alcohol dependent patients. Given the frequency with which the condition is seen in other countries, the possibility exists that many cases may be unrecognised and misdiagnosed in UK EDs. AKA should be included in the differential diagnosis of alcohol dependent patients presenting with acute illness. Management is based around exclusion of serious pathology and specific treatment for AKA where it is present.
What to Know About Alcoholic Ketoacidosis
Larger studies by Fulop and Hoberman5 and Wrenn et al6 (24 and 74 patients, respectively) clarified the underlying acid base disturbance. Although many patients had a significant ketosis with high plasma BOHB levels (5.2–14.2 mmol/l), severe acidaemia was uncommon. Elevated cortisol levels can increase fatty acid mobilization and ketogenesis. Growth hormone can enhance precursor fatty acid release and ketogenesis during insulin deficiency. Catecholamines, particularly epinephrine, increase fatty acid release and enhance the rate of hepatic ketogenesis.
What is Alcoholic Ketoacidosis?
- Increased ketogenesis secondary to the utilization of hepatic glycogen stores, with subsequently increased lipolysis and a decreased insulin-to-glucagon ratio, causes starvation ketosis.
- With timely and aggressive intervention, the prognosis for a patient with AKA is good.
- When your liver uses up its stored glucose and you aren’t eating anything to provide more, your blood sugar levels will drop.
When your liver uses up its stored glucose and you aren’t eating anything to provide more, your blood sugar levels will drop. The hallmark of AKA is ketoacidosis without marked hyperglycemia; the serum glucose level may be low, normal, or slightly elevated. 4 This finding can help to distinguish AKA from diabetic ketoacidosis (DKA). Alcoholic ketoacidosis is a relatively rare condition, which may have a lethal outcome if left untreated.
Alcoholic Ketoacidosis
This review covers definition, pathophysiology, clinical manifestations, diagnostic approach and treatment. Usually, patients respond well and quickly to treatment, if it is started early in the alcoholic ketoacidosis course. Take our free, 5-minute alcohol abuse self-assessment below if you think you or someone you love might be struggling with alcohol abuse.
Lactic acidosis
In 1940, Dillon et al1 described a series of nine patients who Alcohol Use Disorder had episodes of severe ketoacidosis in the absence of diabetes mellitus, all of whom had evidence of prolonged excessive alcohol consumption. It was not until 1970 that Jenkins et al2 described a further three non‐diabetic patients with a history of chronic heavy alcohol misuse and recurrent episodes of ketoacidosis. This group also proposed a possible underlying mechanism for this metabolic disturbance, naming it alcoholic ketoacidosis. AKA results from the accumulation of the hydroxybutyric acid, acetoacetic acid (true ketoacid), and acetone. 5, 12 Such accumulation is caused by the complex interaction stemming from alcohol cessation, decreased energy intake, volume depletion, and the metabolic effects of hormonal imbalance. Alcoholic ketoacidosis is a condition that can happen when you’ve had a lot of alcohol and haven’t had much to eat or have been vomiting.
- The prevalence of AKA in a given community correlates with the incidence and distribution of alcohol abuse in that community.
- In 1940, Dillon et al1 described a series of nine patients who had episodes of severe ketoacidosis in the absence of diabetes mellitus, all of whom had evidence of prolonged excessive alcohol consumption.
- Clinicians underestimate the degree of ketonemia if they rely solely on the results of laboratory testing.
- Although many patients had a significant ketosis with high plasma BOHB levels (5.2–14.2 mmol/l), severe acidaemia was uncommon.
- Alcoholic ketoacidosis is a relatively rare condition, which may have a lethal outcome if left untreated.
Clinicians underestimate the degree of ketonemia if they rely solely on the results of laboratory testing. Alcoholic ketoacidosis is usually triggered by an episode of heavy drinking. If you can’t eat for a day or more, your liver will use up its stored-up glucose, which is a type of sugar.
Several mechanisms are responsible for dehydration, including protracted vomiting, decreased fluid intake, and inhibition of antidiuretic hormone secretion by ethanol. Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels. The greatest threats to patients with alcoholic ketoacidosis are marked contraction in extracellular fluid volume (resulting in shock), hypokalaemia, hypoglycaemia, and acidosis.