What Is Alcoholic Ketoacidosis? The Impact of a Buildup of Ketones in Your Blood

The role of lactate, as well as the potential development of alkalosis or acid-base disturbances, is significant in understanding this condition. 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. 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. The prognosis for alcoholic ketoacidosis is good as long as it’s treated early.

Signs and symptoms

• 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.
• Dehydration and volume constriction directly decrease the ability of the kidneys to excrete ketoacids.
• The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department.
• If you were to ignore your symptoms, though, you could end up with a life-threatening condition like a heart attack or seizure, or a differential diagnosis.
• However, the long-term prognosis depends on the severity of the underlying alcohol abuse disorder.
• With timely and aggressive intervention, the prognosis for a patient with AKA is good.

You may get vitamin supplements to treat malnutrition caused by excessive alcohol use. Patients with AKA typically do not require transfer, unless coexisting conditions require a higher level of care. Join 40,000+ People Who Receive Our Newsletter Get valuable resources on addiction, recovery, wellness, and our treatments delivered directly to your inbox. The prevalence of AKA in a given community correlates with the incidence and distribution of alcohol abuse in that community.

Emergent Treatment of Alcoholic Ketoacidosis

At our treatment centers, we offer the medical attention you need, combined with the caring, confidential services you deserve. Our team is skilled at helping individuals overcome the negative effects of alcohol abuse and get on the road to lasting recovery. Chronic alcohol use may lead to ketoacidosis, but it can also have severe and far-reaching effects on your health and relationships that aren’t reversible. Take our free, 5-minute alcohol abuse self-assessment below if you think you or someone you love might be struggling with alcohol abuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an alcohol use disorder.

Sign Up & Get Our FREE Recovery Guide

If the patient’s blood glucose level is significantly elevated, AKA may be indistinguishable from diabetic ketoacidosis (DKA). 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 alcohol. Alcoholic ketoacidosis doesn’t occur more often in any particular race or sex.

Fluid resuscitation, carbohydrate administration, and thiamine supplementation are the mainstays of treatment in alcoholic ketoacidosis (AKA). 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 is also commonly accompanied by the symptoms of dehydration, which include feeling thirsty, weak, dizzy, and lightheaded. If you were to ignore your symptoms, though, you could end up with a life-threatening condition like a heart attack or seizure, or a differential diagnosis.

However, the long-term prognosis depends on the severity of the underlying alcohol abuse disorder. The long-term outlook for recovery following alcoholic ketoacidosis depends on various factors, including your overall health, the extent of organ damage, and your average alcohol intake. If you have existing liver disease in conjunction with AKA, the prognosis may be less favorable. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis.

Alcoholic Ketoacidosis: Warning Signs and Treatments

• The pathophysiology of alcoholic ketoacidosis is complex, involving the excessive production of ketones, which, along with dextrose administration, can impact blood pH levels.
• Limiting the amount of alcohol you drink will help prevent this condition.
• The decreased insulin-to-glucagon ratio that occurs in starvation indirectly reduces the inhibition on CAT activity, thereby allowing more free fatty acids to undergo oxidation and ketone body formation.
• 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.
• These agents are rarely used for the management of severe metabolic acidosis.
• Exclude other causes of autonomic hyperactivity and altered mental status.

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. Evaluate the patient for signs of alcohol withdrawal syndrome, which may include tremors, agitation, diaphoresis, tachycardia, hypertension, seizures, or delirium. Exclude other causes of autonomic hyperactivity and altered mental status. If the diagnosis of alcohol withdrawal syndrome is established, consider the judicious use of benzodiazepines, which should be titrated to clinical response.

The patient might be tachycardic, tachypneic, profoundly orthostatic, or frankly hypotensive as a result of dehydration from decreased oral intake, diaphoresis, and vomiting. 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, alcohol ketosis dangerous which is a type of sugar. When your liver uses up its stored glucose and you aren’t eating anything to provide more, your blood sugar levels will drop. The pathophysiology of alcoholic ketoacidosis is complex, involving the excessive production of ketones, which, along with dextrose administration, can impact blood pH levels.

Clinical Scenario

• We are highly confident that the true effect lies close to that of the estimate of the effect.
• Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels.
• Prolonged vomiting leads to dehydration, which decreases renal perfusion, thereby limiting urinary excretion of ketoacids.
• Conversely, when ketoacidosis is identified, but its origin is unrelated to alcohol, medical professionals may explore other diagnostic possibilities.
• It can be helpful to understand the basic guidelines for alcohol consumption so you can determine whether you are drinking above recommended levels and engaging in potentially harmful alcohol use.

(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. 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. It most often occurs in a malnourished person who drinks large amounts of alcohol every day.

Metabolic acidosis in the alcoholic: a pathophysiologic approach

If you chronically abuse alcohol, you probably don’t get as much nutrition as your body needs. Going on a drinking binge when your body is in a malnourished state may cause abdominal pain, nausea, or vomiting. Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder. Triglycerides stored in adipose tissue undergo lipolysis and are released into the circulation as free fatty acids bound ionically to albumin.