Understanding Alcoholic Ketoacidosis EMRA

Then an IV infusion of 5% dextrose in 0.9% saline solution is given. Initial IV fluids should contain added water-soluble vitamins and magnesium, with potassium replacement as required. The absence of hyperglycemia makes diabetic ketoacidosis improbable. Patients with mild hyperglycemia may have underlying diabetes mellitus Diabetes Mellitus (DM) Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia… Read more , which may be recognized by elevated levels of glycosylated hemoglobin (HbA1C).

The prognosis for alcoholic ketoacidosis is good as long as it’s treated early. However, the long-term prognosis depends on the severity of the underlying alcohol abuse disorder. The major causes of death in people with alcoholic ketoacidosis are diseases that occur along with the alcoholic ketoacidosis and may have caused it, such as pancreatitis, gastrointestinal bleeding, and alcohol withdrawal. Patients with DKA may have a myriad of symptoms on presentation, usually within several hours of the inciting event. Symptoms of hyperglycemia are common, including polyuria, polydipsia, and sometimes more severe presentations include unintentional weight loss, vomiting, weakness, and mentation changes. Dehydration and metabolic abnormalities worsen with progressive uncontrolled osmolar stress, which can lead to lethargy, obtundation, and may even cause respiratory failure, coma, and death.

Differential Diagnosis

When this happens, it can cause ketones, which are acids, to build up in your blood. If not treated quickly, alcoholic ketoacidosis may be life-threatening. On physical exam, most of the patients with ketoacidoses present with features of hypovolemia from gastrointestinal or renal fluid and electrolyte losses. In severe cases, patients may be hypotensive and in frank shock. They may have a rapid and deep respiratory effort as a compensatory mechanism, known as Kussmaul breathing.

If you have any additional complications during treatment, this will also affect the length of your hospital stay. If you or someone else has symptoms of alcoholic ketoacidosis smell, seek emergency medical help. The condition is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids. The diabetic nurse should follow all outpatients to ensure medication compliance, followup with clinicians, and adopting a positive lifestyle. Further, the nurse should teach the patient how to monitor home blood glucose and the importance of careful monitoring of blood sugars during infection, stress, or trauma.

Workup in alcoholic ketoacidosis

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.

The dextrose will also increase glycogen stores and diminish counterregulatory hormone levels. It is essential to administer thiamine before any glucose administration to avoid Wernicke’s encephalopathy preci[itation. If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized. Other electrolyte abnormalities concomitantly present with alcohol abuse and poor oral intake include hypomagnesemia and hypophosphatemia. Magnesium and phosphate levels should be measured and repleted if the serum levels are found low. The reversal of ketosis and vigorous rehydration are central in the management of AKA.

Hydrofluoric Acid Related Injuries and Illness for First Responders

He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. Make your tax-deductible gift and be a part of the cutting-edge research and care that’s changing medicine. As rehydration progresses and adequate renal function is established, consider electrolyte replacement, giving particular attention to potassium and magnesium. Note information about the patient’s social situation and the presence of intoxicating agents besides alcohol.

Efficient 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 remainder of the patient’s laboratory evaluation – including liver enzymes, amylase, and lipase – were within normal limits, and methanol, ethylene glycol, salicylate, and digoxin levels were negative. Of note in the table above, the patient’s INR was greater than 11, above the upper limit of the assay, and this was confirmed by repeating the test. If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors.

The conversion to acetyl CoA and subsequent entry into various pathways or cycles, one of which is the ketogenesis pathway is determined by the availability of insulin in proportion to the counter-regulatory hormones, which are discussed in more detail below. Alcoholic ketoacidosis is a recognised acute complication in alcohol dependent patients. Given the frequency with which the condition is seen in other countries, the possibility exists that many cases may be unrecognised and misdiagnosed in UK EDs. AKA should be included in the differential diagnosis of alcohol dependent patients presenting with acute illness. Management is based around exclusion of serious pathology and specific treatment for AKA where it is present. A possible link between AKA and sudden death in chronic alcoholism has been proposed but remains unconfirmed.