Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment

If your blood glucose level is elevated, your doctor may also perform a hemoglobin A1C (HgA1C) test. This test will provide information about your sugar levels to help determine whether you have diabetes. Each of these situations increases the amount of acid in the system. They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones. Glucose comes from the food you eat, and insulin is produced by the pancreas. When you drink alcohol, your pancreas may stop producing insulin for a short time.

Symptoms of Alcoholic Ketoacidosis

Without insulin, most cells cannot get energy from the glucose that is in the blood. Cells still need energy to survive, so they switch to a back-up mechanism to obtain energy. Fat cells begin breaking down, producing compounds called ketones.

Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment

When this happens, it can cause ketones, which are acids, to build up in your blood. If not treated quickly, alcoholic ketoacidosis may be life-threatening. Typically, an alcohol binge leads to vomiting and the cessation of alcohol or food intake for ≥ 24 hours. During this period of starvation, vomiting continues and abdominal pain develops, leading the patient to seek medical attention. In some instances, doctors may also assess for lactic acidosis, a condition characterized by an excessive buildup of lactic acid in the bloodstream.

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• These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis.
• Free fatty acids are removed by the liver, where they primarily undergo oxidation to hydroxybutyric acid and acetoacetate and subsequently are reesterified to triglyceride.
• The test is free, confidential, and no personal information is needed to receive the result.
• However, if an individual presents with symptoms of ketoacidosis but is not found to be in a state of ketoacidosis, healthcare providers will investigate alternative conditions like alcohol poisoning.
• Alcoholic ketoacidosis (AKA) is a condition seen commonly in patients with alcohol use disorder or after a bout of heavy drinking.

These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis. They provide some energy to your cells, but too much may cause your blood to become too acidic. The absence of hyperglycemia makes diabetic ketoacidosis improbable. Patients with mild hyperglycemia may have underlying diabetes mellitus, which may be recognized by elevated levels of glycosylated hemoglobin (HbA1C).

Who Is at Risk for Alcoholic Ketoacidosis?

If history does not rule out toxic alcohol ingestion as a cause of the elevated anion gap, serum methanol and ethylene glycol levels should be measured. 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 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. Alcoholic ketoacidosis (AKA) is a condition seen commonly in patients with alcohol use disorder or after a bout of heavy drinking. It is a clinical diagnosis with patients presenting with tachycardia, tachypnea, dehydration, agitation, and abdominal pain. This activity illustrates the evaluation and treatment of alcoholic ketoacidosis and explains the role of the interprofessional team in managing patients with this condition.

Treatment approaches will depend on the specific diagnosis derived from these investigations, allowing healthcare providers to deliver tailored care. Conversely, when ketoacidosis is identified, but its origin is unrelated to alcohol, medical professionals may explore other diagnostic possibilities. This may involve conducting tests to rule out conditions such as starvation ketosis. Your body typically produces ketone bodies when breaking down fat for energy, but their levels can rise significantly if you consume a lot of alcohol and don’t eat enough. (2)  This can rapidly lead to AKA, which may manifest even after a single binge-drinking episode, especially if you abstain from eating for an extended period. Without enough insulin, the body can’t use sugar to make the energy it needs.

• It also depends on how long it takes to get your body regulated and out of danger.
• Cells still need energy to survive, so they switch to a back-up mechanism to obtain energy.
• Your body typically produces ketone bodies when breaking down fat for energy, but their levels can rise significantly if you consume a lot of alcohol and don’t eat enough.
• This buildup of ketones can produce a life-threatening condition known as ketoacidosis.

You can prevent alcoholic ketoacidosis by limiting your alcohol intake. You can learn how to reduce your alcohol intake or eliminate it altogether. Joining a local chapter of Alcoholics Anonymous may provide you with the support you need to cope. You should also follow all of your doctor’s recommendations to ensure proper nutrition and recovery.

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Your prognosis will be impacted by the severity of your alcohol use and whether or not you have liver disease. Prolonged used of alcohol can result in cirrhosis, or permanent scarring of the liver. Cirrhosis of the liver can cause exhaustion, leg swelling, and nausea. But don’t let fear keep you from taking good care of yourself. Limiting the amount of alcohol you drink will help prevent this condition. The metabolism of alcohol itself is a probable contributor to the ketotic state.

The doctor must exclude these other causes before diagnosing alcoholic ketoacidosis. Alcoholic ketoacidosis most commonly happens in people who have alcohol use disorder and chronically drink a lot of alcohol. But it can happen after an episode of binge drinking in people who do not chronically abuse alcoholic ketoacidosis smell alcohol. Alcoholic ketoacidosis doesn’t occur more often in any particular race or sex. Triglycerides stored in adipose tissue undergo lipolysis and are released into the circulation as free fatty acids bound ionically to albumin. Free fatty acids are removed by the liver, where they primarily undergo oxidation to hydroxybutyric acid and acetoacetate and subsequently are reesterified to triglyceride.