What Is Alcoholic Ketoacidosis? The Impact of a Buildup of Ketones in Your Blood

Death is not inevitable if only a small amount of methanol has been consumed, and rapid treatment will greatly reduce damage. The prevalence of AKA in a given community correlates with the incidence and distribution of alcohol abuse in that community. 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. Drinking only mass-produced commercial brews can be safer, though understandably people often want to try locally made drinks as part of their adventure.

Clinical Bottom Line

If you develop any of these symptoms, seek emergency medical attention. Methanol can turn up in any alcoholic beverage, but it’s most likely in beverages with higher alcohol content, such as spirits, and traditionally brewed drinks, such as fruit wines. The pair are reportedly among several foreign nationals to become ill after unknowingly consuming alcoholic drinks containing methanol in the south-east Asian country. Following resuscitation, our patient had plasma electrolyte levels corrected, nutritional supplementation provided and completed an alcohol detoxification regimen. Given the early recognition of AKA and concurrent management, our patient had a good outcome. She was discharged alcohol acidosis home and has been well on follow-up appointments.

Symptoms of Alcoholic Ketoacidosis

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.

• 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.
• Additional measurements that may help determine the diagnosis of AKA include beta-hydroxybutyrate levels (high in AKA, low in DKA) and serum alcohol concentration (typically low or undetectable) 8.
• This drop in blood sugar causes your body to decrease the amount of insulin it produces.
• The key principle of emergency management is adequate fluid resuscitation 10.
• They provide some energy to your cells, but too much may cause your blood to become too acidic.

What to Know About Alcoholic Ketoacidosis

• With timely and aggressive intervention, the prognosis for a patient with AKA is good.
• The dextrose will also increase glycogen stores and diminish counterregulatory hormone levels.
• Meetings are widely available at little-to-no cost in most communities.
• 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.

The key principle of emergency management is adequate fluid resuscitation 10. Increasing volume status and providing increased perfusion to tissues help reduce lactic acid, ketoacids and acetic acid, which would all have been contributing to the severe acidosis. Lactic acidosis occurs when ethanol metabolism results in a high hepatic NADH/NAD ratio, diverting pyruvate metabolism towards lactate and inhibiting gluconeogenesis. In peripheral tissues, where NADH levels are lower, this lactate may be converted to pyruvate for metabolic needs. Pyruvate and lactate are then maintained in steady state at much higher levels than normal.

People with this condition are usually admitted to the hospital, often to the intensive care unit (ICU). 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. Jenkins et al2 suggested that alcohol induced mitochondrial damage might account for AKA.

• Alcoholic ketoacidosis is usually triggered by an episode of heavy drinking.
• Without insulin, most cells cannot get energy from the glucose that is in the blood.
• Your prognosis will be impacted by the severity of your alcohol use and whether or not you have liver disease.
• By contrast, methanol is metabolized into formaldehyde (a chemical used in industrial glues and for embalming corpses, for example) and then to formic acid (the chemical in some ant bites that makes them hurt so much).
• During this period of starvation, vomiting continues and abdominal pain develops, leading the patient to seek medical attention.

History and Physical

Elevated cortisol levels can increase fatty acid mobilization and ketogenesis. Growth hormone can enhance precursor fatty acid release and ketogenesis during insulin deficiency. Catecholamines, particularly epinephrine, increase fatty acid release and enhance the rate of hepatic ketogenesis.

Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism. Take our free, 5-minute alcohol abuse self-assessment below if you think you or someone you love might be struggling with alcohol abuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an alcohol use disorder. The test is free, confidential, and no personal information is needed to receive the result. Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated. The toxicokinetics that are pertinent to the diagnosis of AKA include the rate of alcohol oxidation in the body.

What causes alcoholic ketoacidosis?

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. Wrenn et al found altered mental status in 15% of patients, attributable in all but one case to hypoglycaemia, severe alcohol intoxication, or infection. Fever was seen in only two patients, both with other likely underlying causes. The metabolism of alcohol itself is a probable contributor to the ketotic state.