Alcoholic Ketoacidosis: Etiologies, Evaluation, and Management
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- Those enzymes are secreted directly into the gut to ensure effective food digestion.
- Both Wrenn et al6 and Fulop and Hoberman5 found evidence of alcoholic hepatitis to be common, with frequent elevations in serum transaminase activities and bilirubin.
- Triglycerides stored in adipose tissue undergo lipolysis and are released into the circulation as free fatty acids bound ionically to albumin.
- For patient education information, see the Mental Health and Behavior Center, as well as Alcoholism and Alcohol Intoxication.
- 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.
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 alcoholic ketoacidosis smell 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.
What are the complications of alcoholic ketoacidosis?
The authors conclude that making an accurate diagnosis may be more challenging in people with psychiatric disorders, as these individuals may not be able to provide an accurate history of their health or eating habits. During starvation ketoacidosis, fatty acids replace glucose as the primary source of fuel for the body. It happens when a person has undergone an extended period of fasting.
Similar symptoms in a person with alcohol use disorder Alcohol Use Alcohol (ethanol) is a depressant (it slows down brain and nervous system functioning). Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma,… Read more may result from acute pancreatitis Acute Pancreatitis Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening but usually subsides. Gallstones and alcohol abuse are the main causes of acute pancreatitis. Read more , methanol (wood alcohol) or ethylene glycol (antifreeze) poisoning or diabetic ketoacidosis Diabetic Ketoacidosis Diabetic ketoacidosis is an acute complication of diabetes that occurs mostly in type 1 diabetes mellitus. Symptoms of diabetic ketoacidosis include nausea, vomiting, abdominal pain, and a characteristic…
Electrolyte disturbances in patients with chronic alcohol-use disorder
As mentioned earlier in this article, poor food intake can lead to depleted glycogen levels. Furthermore, continued alcohol metabolism results in diminished gluconeogenesis. Both the depletion of glycogen and diminished gluconeogenesis lead to lower blood sugar levels. Because insulin restrains glucagon secretion, lower insulin secretion allows increased glucagon secretion, setting the stage for the development of ketoacidosis.
- The next important step in the management of AKA is to give isotonic fluid resuscitation.
- It is essential to differentiate AKA from DKA to ensure that inappropriate insulin administration does not occur.
- Ketoacidosis, which occurs primarily in diabetics, is a condition characterized by excessive levels of certain acids called ketone bodies (e.g., acetone, acetoacetate, and β-hydroxybutyrate) in the blood.
- Growth hormone, epinephrine, cortisol, and glucagon are all increased.
Abstinence from alcohol generally leads to normalization of the triglyceride levels, unless the person has an underlying genetic predisposition for hypertriglyceridemia. The presence of a high anion gap, although not specific, is suggestive of AKA in a patient with an appropriate clinical history . Additional measurements that may help determine the diagnosis of AKA include beta-hydroxybutyrate levels (high in AKA, low in DKA) and serum alcohol concentration (typically low or undetectable) . The key principle of emergency management is adequate fluid resuscitation . Increasing volume status and providing increased perfusion to tissues help reduce lactic acid, ketoacids and acetic acid, which would all have been contributing to the severe acidosis. A 49-year-old male with a history of alcohol abuse presents to the ED with complaints of generalized abdominal pain and vomiting for the last 36 hours.
Metabolism of ethanol
You may get vitamin supplements to treat malnutrition caused by excessive alcohol use. Although the underlying pathophysiology is complex, a proper comprehension greatly aids in the diagnosis and management of this condition. Another complication is that a person may experience lethargy and a severe loss of strength because the body has begun to break down muscle. The majority of papers detected by this search focus primarily on diabetes mellitus and its complications, and were excluded. General literature reviews, single case reports, and letters were also excluded.
Dextrose is required to break the cycle of ketogenesis and increase insulin secretion. 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.
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