In cases where alcohol consumption is suspected as the cause, doctors will consider this information alongside clinical symptoms. People who consume a lot of alcohol during one occasion often vomit repeatedly and stop eating. If the vomiting and starvation go on for a day or more, the liver’s normal stores of sugar (glucose) decrease. The low glucose stores combined with lack of food intake cause low blood glucose levels. 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.
Health Conditions
However, this condition is often seen in individuals with a history of alcohol use disorder who experience periods of heavy drinking (binge drinking) followed by inadequate food intake or vomiting. AKA develops due to the body’s inability to source adequate glucose, leading it to metabolize fat into ketones for energy. Elevated levels of these ketones lead to a high anion gap metabolic acidosis, a state where the blood becomes too acidic. Alcoholic ketoacidosis most commonly occurs in individuals with a history of binge drinking or chronic alcohol use. They may alcoholic ketoacidosis present to medical attention with severe stomach pain, nausea, and vomiting, and they might not have eaten adequately for days.
- Lactic acid levels are often elevated because of hypoperfusion and the altered balance of reduction and oxidation reactions in the liver.
- This could include referrals to counseling, therapy, or rehabilitation programs, providing you with a structured path toward sustained sobriety.
- (4) Both conditions share similarities, but medical professionals differentiate them through a comprehensive case assessment.
History and Physical
In this article, we will explore what alcoholic ketoacidosis is, how it develops, its signs and symptoms, how it is diagnosed and treated, and Alcohol Use Disorder its potential long-term impacts. Additional risk factors for developing alcoholic ketoacidosis can include pancreatic conditions, liver disease, and a history of recurrent alcoholic ketoacidosis. These factors can make it even harder for the body to manage glucose and ketone levels. Generally, the physical findings relate to volume depletion and chronic alcohol abuse.
- Cirrhosis of the liver can cause exhaustion, leg swelling, and nausea.
- This test will provide information about your sugar levels to help determine whether you have diabetes.
- The dextrose will also increase glycogen stores and diminish counterregulatory hormone levels.
- Without insulin, most cells cannot get energy from the glucose that is in the blood.
- AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels, and a normal or low glucose concentration.
- This serious, acute complication can occur in individuals who drink heavily and have poor nutrition, but it is also treatable and largely preventable with the right interventions.
Deterrence and Patient Education
- Contact us to learn more about alcohol addiction treatment programs that can work well for your needs in recovery.
- The toxicokinetics that are pertinent to the diagnosis of AKA include the rate of alcohol oxidation in the body.
- Antiemetics such as ondansetron or metoclopramide may also be given to control nausea and vomiting.
- It is a clinical diagnosis with patients presenting with tachycardia, tachypnea, dehydration, agitation, and abdominal pain.
- If your blood glucose level is elevated, your doctor may also perform a hemoglobin A1C (HgA1C) test.
These factors collectively contribute to the high anion gap metabolic acidosis characteristic of AKA. Patients who appear significantly ill and those with positive ketones should have arterial blood gas and serum lactate measurements. 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.
Management of Alcohol Withdrawal Syndrome
- 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.
- When your body burns fat for energy, byproducts known as ketone bodies are produced.
- 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.
- The Recovery Village Cherry Hill at Cooper offers comprehensive addiction treatment for drug and alcohol addictions and co-occurring mental health conditions.
1, 2, 3 The diagnosis of AKA requires arterial blood gas (ABG) measurement and serum chemistry assays. Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Diagnosis is by history and findings of ketoacidosis without hyperglycemia. In general, exogenous insulin is contraindicated in the treatment of AKA, because it may cause life-threatening hypoglycemia in patients with depleted glycogen stores. In most cases, the patient’s endogenous insulin levels rise appropriately with adequate carbohydrate and volume replacement. If the patient’s blood glucose level is significantly elevated, AKA may be indistinguishable from diabetic ketoacidosis (DKA).
Without insulin, your cells won’t be able to use the glucose you consume for energy. Laboratory analysis plays a major role in the evaluation of a patient with suspected alcoholic ketoacidosis. Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated. Elevated cortisol levels can increase fatty acid mobilization and ketogenesis. Growth hormone can enhance precursor fatty acid release and ketogenesis during insulin deficiency.
Prehospital Care
When individuals indulge in heavy drinking, it leads to a cascade of physiological changes in the body, creating a perfect storm for alcoholic ketosis. Free fatty acids are either oxidized to CO2 or ketone bodies (acetoacetate, hydroxybutyrate, and acetone), or they are esterified to triacylglycerol and phospholipid. Carnitine acyltransferase (CAT) transports free fatty acids into the mitochondria and therefore regulates their entry into the oxidative pathway.