Alcoholic ketoacidosis: MedlinePlus Medical Encyclopedia

Posted October 25th, 2022 by Violett

They also need to have a complete history and physical for a complete differential diagnosis. Besides excessive alcohol consumption, not eating enough and vomiting due to alcohol use can also cause the body to reduce its production of insulin and lead to alcoholic ketoacidosis. All forms of ketoacidosis require treatment of the underlying disease to normalize the rate of ketogenesis and allow for metabolism of accumulated ketones so that bicarbonate can be regenerated. A 1991 case series found that the most common symptoms among 74 patients presenting with AKA are nausea (76%), vomiting (73%), and abdominal pain (62%). These symptoms often develop one to two days before ketoacidosis and are due to other effects of alcohol, like gastritis. They may be the reason that patients abruptly stop drinking, triggering ketoacidosis. Though these abdominal complaints are common, they are less commonly accompanied by signs such as abdominal distension, hypoactive bowel sounds, or rebound tenderness.

How do you treat alcoholic ketoacidosis?

Treatment of alcoholic ketoacidosis involves administering IV fluids, monitoring electrolyte levels, and administering thiamine followed by glucose, if needed. Medications (i.e., benzodiazepines) may be administered to minimize the risk of experiencing severe symptoms of alcohol withdrawal.

Typically the postmortem forensic toxicology in cases of AKA reveal a normal or low blood sugar level, very high acetone concentrations , and a negative or low blood alcohol concentration. For over 50 years, we’ve been administering evidence-based treatments with a compassionate approach to help patients find lasting freedom from addiction. We’ll be with you for life, with various inpatient and outpatient services, including an alumni support network. To learn how you can start a journey toward recovery, contact us at Gateway Foundation today. Following resuscitation, our patient had plasma electrolyte levels corrected, nutritional supplementation provided and completed an alcohol detoxification regimen. Given the early recognition of AKA and concurrent management, our patient had a good outcome.

What Causes Alcoholic Ketoacidosis?

Clinicians underestimate the degree of ketonemia if they rely solely on the results of laboratory testing. 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 alcoholic ketoacidosis you with the support you need to cope. You should also follow all of your doctor’s recommendations to ensure proper nutrition and recovery. Your doctor may also admit you to the intensive care unit if you require ongoing care. The length of your hospital stay depends on the severity of the alcoholic ketoacidosis.

what is alcoholic ketoacidosis

Fluids alone do not correct the ketoacidosis as fast as fluids and glucose administered together. Glucose stimulates insulin production, which stops lipolysis and halts further ketone formation. Glucose also increases oxidation of NADH to NAD, thereby further stopping ketone production. Once fluid and electrolyte losses are replaced, change fluids to 5% dextrose in half normal saline until oral intake is assured.1 Patients with alcoholic ketoacidosis are not hyperosmolar. Unlike treatment of diabetic ketoacidosis, cerebral edema is of little concern with large volumes of fluid administration. Even with vigorous fluid resuscitation, in our review of the literature, cerebral edema has not been reported among those being treated for alcoholic ketoacidosis. Alcoholic ketoacidosis is a condition that presents with a significant metabolic acidosis in patients with a history of alcohol excess.


AKA results from the accumulation of the hydroxybutyric acid, and acetoacetic acid , and acetone. Such accumulation is caused by the complex interaction stemming from alcohol cessation, decreased energy intake, volume depletion, and the metabolic effects of hormonal imbalance. These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis. 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.

An elevated anion gap metabolic acidosis and ketosis is the classic present. However, a mixed acid-base disorder may be present especially if vomiting is contributing to a hypochloremic alkalosis. The ketone which is present is mostly beta-hydroxybutyrate rather than acetoacetate resulting in only a weakly positive nitroprusside test. People usually do not present with high blood sugar or sugar in the urine. This can cause false negative results when testing urine ketones as they only measure acetoacetate. Ethanol level are often low or negative despite a chronic alcohol use history. Electrolyte disturbances may include hypokalemia or hypomagnesemia may also be present.

What Is Alcoholic Ketoacidosis?

AKA most commonly occurs in long term alcoholics and less commonly in those who binge drink. Onset is generally after a decreased ability to eat for a few days.

  • If you or a loved one experiences any of these symptoms, especially after binge drinking, seek professional help immediately.
  • If you’ve suffered symptoms of AKA, seek help from a professional treatment center.
  • Oxidation of ethanol to acetaldehyde also produces molecules of NADH, which suppress gluconeogenesis through negative feedback, further exacerbating hypoglycemia and the production of ketones.
  • This leads to your body burning fat for energy instead of using the glucose you consume.
  • Calcium oxalate crystals in the urine also suggests ethylene glycol poisoning.
  • The nitroprusside reagent used to measure urine and serum ketones measures acetoacetate.

In other words, it can occur when you drink too much alcohol on an empty stomach. As a result, ketones build up in the bloodstream, which can be life-threatening without treatment. Today we’re looking into what causes this condition and the risks it poses. 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. Decreased insulin and elevated glucagon, cortisol, catecholamine, and growth hormone levels can increase the rate of ketogenesis.

Your doctor and other medical professionals will watch you for symptoms of withdrawal. Review the fluid and volume resuscitation and correction of electrolyte abnormalities used in the treatment of alcoholic ketoacidosis.

what is alcoholic ketoacidosis

Comments are closed.