If the patient’s blood glucose level is significantly elevated, AKA may be indistinguishable from diabetic ketoacidosis (DKA). Toxicity from methanol or ethylene glycol is an important differential diagnosis. Toxic metabolites of both substances result in severe metabolic acidosis with wide anion gap and wide osmolal gap.18 Neither, however, causes ketosis.
Complications
This test will provide information about your sugar levels to help determine whether you have diabetes. If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis. This can occur as soon as one day after a drinking binge, depending on nutritional status, overall health status, and the amount of alcohol consumed.
- Diagnosis is by history and findings of ketoacidosis without hyperglycemia.
- Dextrose is required to break the cycle of ketogenesis and increase insulin secretion.
- 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.
- A possible link between AKA and sudden death in chronic alcoholism has been proposed but remains unconfirmed.
- Acetic acid (an acyl group carrier) is linked with coenzyme A (a thiol) to produce Acetyl-CoA.
Alcohol-Related Metabolic Emergencies
Fat cells begin breaking down, producing compounds called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). This ketoacidosis is similar to the ketoacidosis that occurs in diabetes except that, unlike in diabetic ketoacidosis, blood glucose levels are low. Examination should reveal a clear level of consciousness, generalised abdominal tenderness (without peritoneal signs), and tachypnoea. There may be concomitant features of dehydration or early acute alcohol withdrawal. Bedside testing reveals a low or absent breath alcohol, normal blood sugar, metabolic acidosis, and the presence of urinary ketones, although these may sometimes be low or absent.
An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis
The toxicokinetics that are pertinent to the diagnosis of AKA include the rate of alcohol oxidation in the body. Ethyl alcohol oxidizes at a rate of 20 to 25 mg/dL per hour in most individuals. The accompanying lack of alcohol in the patient’s body and the fact that for some time, the only source of calories that a patient has is ethanol both contribute to the clinical syndrome that we see. If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors. Seeking help as soon as symptoms arise reduces your chances of serious complications. Treatment for alcohol addiction is also necessary to prevent a relapse of alcoholic ketoacidosis.
They attributed this to the administration of therapy (intravenous dextrose) rather than the withdrawal of the toxin, ethanol. If indicated, provide follow-up with AKA patients to assess the problem of alcohol abuse. Consider referral to a counselor at an alcohol treatment center. Prevention of AKA involves the treatment of chronic alcohol abuse. Alcoholic ketoacidosis is a problem caused by drinking a lot of alcohol without eating food.
- Triglycerides stored in adipose tissue undergo lipolysis and are released into the circulation as free fatty acids bound ionically to albumin.
- If you develop any of these symptoms, seek emergency medical attention.
- They provide some energy to your cells, but too much may cause your blood to become too acidic.
- Routine clinical assays for ketonemia test for AcAc and acetone but not for β-OH.
- Alcohol dehydrogenase (ADH), a cytosolic enzyme, metabolizes alcohol to acetaldehyde in hepatocytes.
- Alcoholic ketoacidosis can develop when you drink excessive amounts of alcohol for a long period of time.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency alcoholic ketoacidosis smell medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. These agents are rarely used for the management of severe metabolic acidosis. Assess for clinical signs of thiamine deficiency (Wernicke-Korsakoff syndrome).
