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Understanding Alcoholic Ketoacidosis

In the majority of cases, a precipitating event such as pancreatitis, gastritis, or an aspiration pneumonia leads to an abrupt decline in oral intake. About 24 to 72 hours after cessation of PO intake, AKA can develop. These patients usually have a low or absent serum alcohol concentration and can present with varying degrees of alcohol withdrawal. However, a clear sensorium is a hallmark of this condition. The presence of an alteration in consciousness strongly suggests that another process is present.

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  Tasty morsels of EM 038 – Alcoholic Ketoacidosis

Alcoholic Ketoacidosis (AKA) usually occurs during period of abstinence following binge (think of the alcohol withdrawal patient). Lack of available glucose (low glycogen stores and previously abundant alcohol source now that patient is abstinent) leads to ketone body production.

 Alcoholic Ketoacidosis: Mind the Gap, Give Patients What They Need

AKA is a diagnosis of exclusion, and many other life-threatening alternative or concomitant diagnoses present similarly, and must be ruled out. Failure to make the diagnosis can result in severe metabolic abnormalities, acidosis, and shock.

 POTD: Alcoholic Ketoacidosis

Someone who has been on a bender and shows up to your ED after two days of vomiting, has a low bicarb, elevated anion gap, elevated lactate, urine ketones, and an elevated BHB level...probably has AKA. Alcohol + No Food + Dehydration = AKA.

Articles of Interest

Alcoholic ketoacidosis (AKA): how does it present, what’s the pathophysiology, and how do you treat?

The administration of 5% dextrose in 0.9% normal saline at a rate of 7.0 to 7.5 g per hour of dextrose will generally restore hemodynamic stability and correct acid-base disturbances within 12-24 hours. Thiamine should be administered before administering glucose-containing solutions in order to decrease the risk of precipitating Wernicke’s encephalopathy or Korsakoff’s syndrome.

Alcoholic Ketoacidosis—Underrecognized Cause of Metabolic Acidosis in the Elderly

Alcoholic ketoacidosis (AKA) is an acute anion gap metabolic acidosis that typically occurs in people with a recent history of binge drinking and little or no nutritional intake. Some patients with AKA also have intractable vomiting and dehydration, and in these cases there is a concomitant metabolic alkalosis.

EM Journal

Alcoholic ketoacidosis is characterized by an anion gap acidosis due to high levels of ketoacids. It occurs exclusively in relation to alcohol abuse but not just in chronic alcoholics. It has been reported in first-time drinkers whose food intake is minimal.

REBEL Core Cast 100.0 – Alcoholic Ketoacidosis

Alcoholic Ketoacidosis (AKA) can present with significant acidemia (pH < 7.00). Despite the significant acidemia, patients with AKA can remain alert and lucid despite their severe metabolic derangement.

The Syndrome of Alcoholic Ketoacidosis

AKA is a common disorder in the emergency department, more common than previously thought. The acid-base abnormalities are more diverse than just a wide-gap metabolic acidosis and often include a concomitant metabolic alkalosis, hyperchloremic acidosis, or respiratory alkalosis. Lactic acidosis is also common.

Toxcards: Alcoholic Ketoacidosis

The classic laboratory findings in patients with AKA include an elevated anion gap metabolic acidosis and an elevated lactate. Early in AKA patients may be negative for ketones when the nitroprusside test is used because it does not detect beta-hydroxybutyrate. As patients recover, the nitroprusside test will become positive as beta-hydroxybutyrate gets converted to acetone and acetate.

Resources

Core EM

AKA occurs when a malnourished patient with alcohol use disorder stops drinking, and falling ethanol levels increase catecholamines and cortisol, which amplify the hormonal response to the fasting state, accelerating lipolysis and synthesis of ketones. Oxidation of ethanol to acetaldehyde also produces molecules of NADH, which suppress gluconeogenesis through negative feedback, further exacerbating hypoglycemia and the production of ketones.

Life in the Fastlane

Exclude other causes for metabolic acidosis (AKA is a diagnosis of exclusion).

Anesthesia Key

The diagnosis of alcoholic ketoacidosis (AKA) is established when an alcoholic patient is found to have an anion gap metabolic acidosis without historical or laboratory evidence suggesting an alternative cause.

StatPearls

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.