Patients often have a recent bout of heavy drinking before the period of relative starvation, with persistent vomiting alcoholic ketoacidosis and abdominal pain contributing to their inability to tolerate PO intake. 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 altered level of consciousness should prompt consideration of alternative diagnoses such as hypoglycaemia, seizures, sepsis, thiamine deficiency, or head injury.
- If you develop any of these symptoms, seek emergency medical attention.
- Management is based around exclusion of serious pathology and specific treatment for AKA where it is present.
- In patients suspected of having alcoholic ketoacidosis, serum electrolytes (including magnesium), blood urea nitrogen (BUN) and creatinine, glucose, ketones, amylase, lipase, and plasma osmolality should be measured.
- Diagnosis is by history and findings of ketoacidosis without hyperglycemia.
- If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors.
How is alcoholic ketoacidosis diagnosed?
If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help. Nausea, vomiting, and abdominal pain were by far the most commonly observed complaints. Despite the frequency of abdominal symptoms, objective findings other than tenderness were infrequent. Abdominal distension, decreased bowel sounds, ascites, or rebound tenderness occurred rarely and only in the presence of other demonstrable intra‐abdominal pathology such as pancreatitis, severe hepatitis, and sepsis or pneumonia. Both Wrenn et al6 and Fulop and Hoberman5 found evidence of alcoholic hepatitis to be common, with frequent elevations in serum transaminase activities and bilirubin.
Conditions
The doctor must exclude these other causes before diagnosing alcoholic ketoacidosis. Alcoholic ketoacidosis (AKA) is a condition seen commonly in patients with alcohol use disorder or after a bout of heavy drinking. It is a clinical diagnosis with patients presenting with tachycardia, tachypnea, dehydration, agitation, and abdominal pain. This activity illustrates the evaluation and treatment of alcoholic ketoacidosis and explains the role of the interprofessional team in managing patients with this condition. Lactic acidosis occurs when ethanol metabolism results in a high hepatic NADH/NAD ratio, diverting pyruvate metabolism towards lactate and inhibiting gluconeogenesis.
What Is the Prognosis for Alcoholic Ketoacidosis?
Efficient drug addiction and timely management can lead to enhanced patient outcomes in patients with AKA. However, after adequate treatment, it is equally essential to refer the patient to alcohol abuse rehabilitation programs to prevent recurrence and long-term irreversible damage from alcohol abuse. The absence of hyperglycemia makes diabetic ketoacidosis improbable. Patients with mild hyperglycemia may have underlying diabetes mellitus, which may be recognized by elevated levels of glycosylated hemoglobin (HbA1C). The condition is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids.
- The greatest threats to patients with alcoholic ketoacidosis are marked contraction in extracellular fluid volume (resulting in shock), hypokalaemia, hypoglycaemia, and acidosis.
- The absence of hyperglycemia makes diabetic ketoacidosis improbable.
- A possible link between AKA and sudden death in chronic alcoholism has been proposed but remains unconfirmed.
- Jenkins et al2 suggested that alcohol induced mitochondrial damage might account for AKA.
Group meetings provide support for people trying to quit drinking. 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. Acetyl CoA may be metabolised to carbon dioxide and water, converted to fat, or combined with another acetyl CoA =https://ecosoberhouse.com/ to form acetoacetate (fig 1).
Possible Complications
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. Treatment may involve fluids (salt and sugar solution) given through a vein. You may get vitamin supplements to treat malnutrition caused by excessive alcohol use.
Differential diagnosis
They attributed this to the administration of therapy (intravenous dextrose) rather than the withdrawal of the toxin, ethanol. 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. These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis. They provide some energy to your cells, but too much may cause your blood to become too acidic.
