From the Guidelines
Alcoholic ketoacidosis is a serious metabolic condition characterized by high levels of ketones in the blood, metabolic acidosis, and often an elevated anion gap, primarily occurring in people with chronic alcohol use disorder who have had a recent period of heavy drinking followed by reduced food intake or vomiting. This condition develops when the body breaks down fat instead of glucose for energy, producing ketones that make the blood too acidic. Symptoms typically include nausea, vomiting, abdominal pain, confusion, fatigue, and rapid breathing. Treatment involves intravenous fluids with dextrose to restore hydration and provide glucose, electrolyte replacement (particularly potassium, magnesium, and phosphate), and thiamine supplementation to prevent Wernicke's encephalopathy 1. Insulin may sometimes be needed if blood glucose levels are elevated. The underlying mechanism involves multiple factors: alcohol inhibits gluconeogenesis (the production of new glucose), depletes glycogen stores, increases fat breakdown, and causes dehydration through vomiting and poor intake. Additionally, the metabolism of alcohol produces NADH, which favors the conversion of pyruvate to lactate rather than to glucose, further contributing to the acidosis. Prompt medical attention is essential as alcoholic ketoacidosis can be life-threatening if untreated. Some key diagnostic criteria for DKA include plasma glucose >250 mg/dl, arterial pH 7.25–7.30, serum bicarbonate 15–18 mEq/l, and positive urine ketones 1. It is also important to distinguish DKA from other causes of high-anion gap metabolic acidosis, such as lactic acidosis, ingestion of certain drugs, and chronic renal failure. The most recent guidelines recommend individualization of treatment based on a careful clinical and laboratory assessment, with management goals including restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, and correction of electrolyte imbalance and acidosis 1.
From the Research
Definition of Alcoholic Ketoacidosis
Alcoholic ketoacidosis (AKA) is defined as a metabolic acidosis with ketosis in a patient with alcohol use 2, 3. It is a common reversible biochemical pathology arising from hyperketonaemia in patients with a history of chronic alcohol consumption 2.
Key Characteristics
- Metabolic acidosis with an elevated anion gap 2, 3, 4, 5, 6
- Ketosis with elevated beta-hydroxybutyrate levels 3, 4
- Frequently presents with a history of alcohol use, poor oral intake, gastrointestinal symptoms, and ketoacidosis on laboratory assessment 3
- Patients are generally dehydrated, and serum glucose can be low, normal, or mildly elevated 3
Diagnosis and Management
- Diagnosis is often delayed or missed, and a precise patient's medical history is crucial to prevent misdiagnosis 2, 5
- Management includes fluid resuscitation, glucose and vitamin supplementation, electrolyte repletion, and evaluation for other conditions 3, 5
- Thiamine and judicious fluid resuscitation as well as electrolytes and malnutrition correction should be promptly initiated in patients with AKA 2