From the Research
Alcoholic ketoacidosis (AKA) is diagnosed based on a combination of clinical history, physical examination, and laboratory findings, with key diagnostic criteria including a history of chronic alcohol abuse, elevated anion gap metabolic acidosis, presence of ketones, and normal or low blood glucose levels, as outlined in the most recent study 1. The diagnosis of AKA involves a thorough evaluation of the patient's history, physical examination, and laboratory results. Key findings include:
- A history of chronic alcohol abuse with recent binge drinking followed by reduced intake or vomiting
- An elevated anion gap metabolic acidosis
- Presence of ketones in blood and urine
- Normal or low blood glucose levels
- Absence of other causes of ketoacidosis Laboratory findings typically show:
- Arterial pH <7.3
- Serum bicarbonate <18 mEq/L
- Elevated beta-hydroxybutyrate levels
- An increased anion gap (>12 mEq/L) Osmolality plays a significant role in diagnosis, as patients often present with an elevated osmolar gap (>10 mOsm/kg) due to the presence of unmeasured osmotically active substances like acetone and other alcohols, as noted in 2 and 3. The most recent and highest quality study 1 prioritizes the diagnosis and management of AKA, emphasizing the importance of targeted therapies and emergency clinician knowledge in caring for these patients. The pathophysiology of AKA involves alcohol-induced inhibition of gluconeogenesis, increased NADH/NAD+ ratio from alcohol metabolism, and elevated counter-regulatory hormones (cortisol, catecholamines) that promote lipolysis and ketogenesis. Treatment focuses on:
- Fluid resuscitation with isotonic saline
- Glucose administration to inhibit ketogenesis
- Electrolyte replacement (particularly potassium, magnesium, and phosphate)
- Thiamine supplementation to prevent Wernicke's encephalopathy, as recommended in 1.