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Starvation ketoacidosis

If the patient is capable, the patient will mount a respiratory alkalosis. Given that severe vomiting can result in metabolic alkalosis, the existence of a mixed condition may also be present. Complete Blood Count – In a dehydrated patient, the WBC (white blood cells), hemoglobin, and hematocrit levels may be raised.

Warfarin overdose was also considered, although the patient repeatedly denied this and reports he did not have access to his medications. Further, vitamin K administration in our patient resulted in normalization of his INR. 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. The patient is well-known to the department for alcohol-related visits and continues to drink daily. On arrival, he is tachycardic and tachypneic, and physical examination findings include dry mucous membranes, decreased sakin turgor, epigastric tenderness, and a tremor in both hands. Laboratory studies show a serum bicarbonate of 10 mEq/L, an anion gap of 30, a serum glucose of 95 mg/dL, a lactic acidosis with pH 7.2, hypophosphatemia, and trace ketonuria.


Chronic alcohol consumption can reduce the amount of glycogen in the liver, and ethanol metabolism further reduces gluconeogenesis. This may result in a decrease in glucose availability, hypoglycemia, and an increased reliance on fatty acid and ketone metabolism. The ethanol metabolism can also raise blood levels of lactic acid, which may alcoholic ketoacidosis also cause metabolic acidosis. Medical professionals use a combination of test results to assess if an individual is in a state of ketoacidosis, a condition characterized by elevated levels of ketones in the blood. These tests include measuring ketone levels, often detecting high concentrations of acetoacetate and beta-hydroxybutyrate.

  • One can prevent AKA from ever occurring by avoiding binge drinking and addressing alcohol abuse early on.
  • Good nutrition is also important, as it keeps the pancreas functioning normally.
  • Alcoholism is a serious, prevalent problem that can have severe consequences.

Intravenous dextrose-containing fluid infusions should be stopped once the bicarbonate levels have reached mEq/L and the patient is tolerating oral intake. This typically occurs 8 to 16 hours after the initiation of treatment.2 Alcohol withdrawal in these patients should be aggressively managed with intravenous benzodiazepines. 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. Alcoholic ketoacidosis is a metabolic condition resulting from excessive alcohol consumption.

Patient Education

Bedside testing reveals a low or absent breath alcohol, normal blood sugar, metabolic acidosis, and the presence of urinary ketones, although these may sometimes be low or absent. An altered level of consciousness should prompt consideration of alternative diagnoses such as hypoglycaemia, seizures, sepsis, thiamine deficiency, or head injury. Arterial blood gas and biochemistry studies reveal a raised anion gap metabolic acidosis without evidence of lactic or diabetic ketoacidosis.

Your doctor and other medical professionals will watch you for symptoms of withdrawal. 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. It also depends on how long it takes to get your body regulated and out of danger. If you have any additional complications during treatment, this will also affect the length of your hospital stay. If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis.

What Causes Alcoholic Ketoacidosis?

The pathophysiology of alcoholic ketoacidosis is complex, involving the excessive production of ketones, which, along with dextrose administration, can impact blood pH levels. The role of lactate, as well as the potential development of alkalosis or acid-base disturbances, is significant in understanding this condition. 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.

  • In the series from Fulop and Hoberman, seven patients were alkalaemic.
  • Other high anion gap metabolic acidosis causes, such as diabetic ketoacidosis, which may also manifest similarly.
  • Having too many ketones in the bloodstream is known as a dangerous condition called ketoacidosis.
  • If you or a loved one experiences any of these symptoms, especially after binge drinking, seek professional help immediately.
  • (4) Both conditions share similarities, but medical professionals differentiate them through a comprehensive case assessment.
  • Your prognosis will be impacted by the severity of your alcohol use and whether or not you have liver disease.

He was seen three weeks later in the emergency department for a similar presentation. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. 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. Alcoholic ketoacidosis occurs in patients who often engage in severe alcoholism.

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