From the Research
The treatment for alcoholic ketoacidosis (AKA) should primarily focus on addressing dehydration, electrolyte imbalances, and metabolic disturbances, with the most recent and highest quality study 1 suggesting that management includes fluid resuscitation, glucose and vitamin supplementation, electrolyte repletion, and evaluation for other conditions. The key components of treatment include:
- Fluid resuscitation with intravenous fluids, typically normal saline (0.9% NaCl), to correct dehydration and electrolyte imbalances
- Administering thiamine (100 mg IV) before giving glucose to prevent precipitating Wernicke's encephalopathy
- Providing glucose, usually as 5% dextrose solution, to reverse the ketosis by stimulating insulin release and inhibiting ketone production
- Electrolyte replacement, particularly potassium, magnesium, and phosphate, as these are commonly depleted
- Monitoring and correcting any acid-base disturbances
- Evaluating for and managing other conditions that may be contributing to the patient's presentation, as suggested by 1 The underlying mechanism of AKA involves depleted glycogen stores, increased lipolysis, and elevated NADH/NAD+ ratio from alcohol metabolism, which collectively promote ketone body formation, as discussed in 1. It is essential to note that morbidity and mortality in AKA are often related to intercurrent illnesses rather than the acidosis itself, as highlighted in 2 and 3. Complete resolution of AKA typically occurs within 24-48 hours with appropriate treatment and cessation of alcohol intake, as supported by the studies 4, 5, and 1.