Intravenous benzodiazepines can be administered based on the risk of seizures from impending alcohol withdrawal. Antiemetics such as ondansetron or metoclopramide may also be given to control nausea and vomiting. Lactic acid levels are often elevated because of hypoperfusion and the altered balance of reduction and oxidation reactions in the liver.
Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department
If your doctor suspects that you’ve developed this condition, they may order additional tests to rule out other possible conditions. After these test results are in, they can confirm the diagnosis. Alcoholic ketoacidosis (AKA) is a common reason for investigation and admission of alcohol dependent patients in UK alcoholic ketoacidosis smell emergency departments. Although well described in international emergency medicine literature, UK emergency physicians rarely make the diagnosis of AKA. There is increasing evidence that rather than being benign and self limiting, AKA may be a significant cause of mortality in patients with alcohol dependence.
- Appropriately evaluate the patient for any life-threatening complications before a transfer is considered.
- The decreased insulin-to-glucagon ratio that occurs in starvation indirectly reduces the inhibition on CAT activity, thereby allowing more free fatty acids to undergo oxidation and ketone body formation.
- Typical characteristics of the latter may include rhinophyma, tremulousness, hepatosplenomegaly, peripheral neuropathy, gynecomastia, testicular atrophy, and palmar erythema.
- Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder.
- Alcoholic ketoacidosis (AKA) is a common reason for investigation and admission of alcohol dependent patients in UK emergency departments.
- If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream.
Differential Diagnosis
Meetings are widely available at little-to-no cost in most communities. Support groups can be a valuable source of support and can be combined with medication and therapy. The majority of papers detected by this search focus primarily on diabetes mellitus and its complications, and were excluded. General literature reviews, single case reports, and letters were also excluded. All remaining papers were retrieved and the reference lists hand searched for any additional information sources.
Deterrence and Patient Education
- If your doctor suspects that you’ve developed this condition, they may order additional tests to rule out other possible conditions.
- Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism.
- Strongly consider providing thiamine supplementation to patients with alcohol dependence even without signs of thiamine deficiency.
- Ethyl alcohol oxidizes at a rate of 20 to 25 mg/dL per hour in most individuals.
- Excessive alcohol consumption often causes malnourishment (not enough nutrients for the body to function well).
It can be helpful to understand the basic guidelines for alcohol consumption so you can determine whether you are drinking above recommended levels and engaging in potentially harmful alcohol use. All chronic alcohol misusers attending the ED should receive intravenous B vitamins as recommended by The Royal College of Physicians.23 Strenuous efforts must be made to exclude concomitant pathology. The metabolism of alcohol itself is a probable contributor to the ketotic state.
Breathing tends to become deep and rapid as the body attempts to correct the blood’s acidity. Similar symptoms in a person with alcohol use disorder may result from acute pancreatitis, methanol (wood alcohol) or ethylene glycol (antifreeze) poisoning or diabetic ketoacidosis. The doctor must exclude these other causes before diagnosing alcoholic ketoacidosis. In general, the prognosis for a patient presenting with AKA is good as long as the condition is identified and treated early.
Alcoholic Ketoacidosis Symptoms
Patients generally do not need to be transferred to special facilities. Appropriately evaluate the patient for any life-threatening complications before a transfer is considered. Fluids alone do not correct AKA as quickly as fluids and carbohydrates together. Thiamine supplementation should also be given upon initiation of dextrose.
- There is increasing evidence that rather than being benign and self limiting, AKA may be a significant cause of mortality in patients with alcohol dependence.
- This results in a decrease in circulating lactic acid and an increase in acetoacetate.
- You can prevent alcoholic ketoacidosis by limiting your alcohol intake.
- Exclude other causes of autonomic hyperactivity and altered mental status.
- Alcoholic ketoacidosis doesn’t occur more often in any particular race or sex.
This literature review discusses the history, characterisation, pathophysiology, diagnosis, and management of AKA. Most cases of AKA occur when a person with poor nutritional status due to long-standing alcohol abuse who has been on a drinking binge suddenly decreases energy intake because of abdominal pain, nausea, or vomiting. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. Alcoholic ketoacidosis is usually triggered by an episode of heavy drinking. If you can’t eat for a day or more, your liver will use up its stored-up glucose, which is a type of sugar.