Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment

You may get vitamin supplements to treat malnutrition caused by excessive alcohol use. Untreated, diabetic ketoacidosis can lead to loss of consciousness and, eventually, death. If you feel ill or stressed or you’ve had a recent illness or injury, check your blood sugar level often. You might also try a urine ketone test kit you can get at a drugstore. 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.

Specifically look for nystagmus, confusion, ataxia, confabulation, and restriction of extraocular movements. Strongly consider providing thiamine supplementation to patients with alcohol dependence even without signs of thiamine deficiency. 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.

Management of Alcohol Withdrawal Syndrome

Generally, the physical findings relate to volume depletion and chronic alcohol abuse. Typical characteristics of the latter may include rhinophyma, tremulousness, hepatosplenomegaly, peripheral neuropathy, gynecomastia, testicular atrophy, and palmar erythema. The patient might be tachycardic, tachypneic, alcoholic ketoacidosis profoundly orthostatic, or frankly hypotensive as a result of dehydration from decreased oral intake, diaphoresis, and vomiting. Several mechanisms are responsible for dehydration, including protracted vomiting, decreased fluid intake, and inhibition of antidiuretic hormone secretion by ethanol.

Differential Diagnosis

The condition is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids. Alcoholic ketoacidosis is the buildup of ketones in the blood due to alcohol use. Ketones are a type of acid that form when the body breaks down fat for energy. There are many ways to prevent diabetic ketoacidosis and other diabetes complications.

Your doctor and other medical professionals will watch you for symptoms of withdrawal. Alcoholic ketoacidosis may lead to gastrointestinal bleeding. Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care. The length of your hospital stay depends on the severity of the alcoholic ketoacidosis.

The dextrose will also increase glycogen stores and diminish counterregulatory hormone levels. It is essential to administer thiamine before any glucose administration to avoid Wernicke’s encephalopathy preci[itation. If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized. Other electrolyte abnormalities concomitantly present with alcohol abuse and poor oral intake include hypomagnesemia and hypophosphatemia. Magnesium and phosphate levels should be measured and repleted if the serum levels are found low. Dextrose stimulates the oxidation of the reduced form of nicotinamide adenine dinucleotide (NADH) and aids in normalizing the ratio of NADH to nicotinamide adenine dinucleotide (NAD+).

Catecholamines, particularly epinephrine, increase fatty acid release and enhance the rate of hepatic ketogenesis.
Fluids alone do not correct AKA as quickly as fluids and carbohydrates together.
Take our free, 5-minute alcohol abuse self-assessment below if you think you or someone you love might be struggling with alcohol abuse.
If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream.
If the diagnosis of alcohol withdrawal syndrome is established, consider the judicious use of benzodiazepines, which should be titrated to clinical response.

The accompanying lack of alcohol in the patient’s body and the fact that for some time, the only source of calories that a patient has is ethanol both contribute to the clinical syndrome that we see. If you develop any of these symptoms, seek emergency medical attention. Sometimes, diabetic ketoacidosis can occur with type 2 diabetes.

In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. During starvation, there is a decrease in insulin secretion and an increase in the production of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone. Hormone-sensitive lipase is normally inhibited by insulin, and, when insulin levels fall, lipolysis is up-regulated, causing release of free fatty acids from peripheral adipose tissue. If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help.