Alcoholic Ketoacidosis: Etiologies, Evaluation, and Management

Medical professionals use a combination of test results to assess if an individual is in a state of ketoacidosis, a condition characterized by elevated levels of ketones in the blood. These tests include measuring ketone levels, often detecting high concentrations of acetoacetate and beta-hydroxybutyrate. Additionally, they may evaluate blood glucose levels, as well as assess for metabolic acidosis by checking factors such as anion gap and bicarbonate levels. In cases where alcohol consumption is suspected as the cause, doctors will consider this information alongside clinical symptoms. Alcoholic ketoacidosis (AKA) is a condition that presents with a significant metabolic acidosis in patients with a history of alcohol excess.

Starvation and Nutrient Depletion

If a person’s ketone levels are high, they should seek immediate medical treatment. Studies suggest that the amount of acetone on a healthy person’s breath correlates with the rate of fat loss. If a person follows a ketogenic diet to lose weight, they may have a slight smell of acetone on their breath. If your blood glucose level is elevated, your doctor may also perform a hemoglobin A1C (HgA1C) test. This test will provide information about your sugar levels to help determine whether you have diabetes. They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones.

Deterrence and Patient Education

• The major cause of morbidity and mortality in patients diagnosed with AKA is under-recognition of concomitant diseases (that may have precipitated the AKA, to begin with).
• Efficient and timely management can lead to enhanced patient outcomes in patients with AKA.
• The ADA recommends testing for ketones every 4–6 hours when a person is ill, such as with a cold or the flu.
• Anyone thinking about trying a keto diet should speak with a doctor first.
• Glucose comes from the food you eat, and insulin is produced by the pancreas.

This overproduction of ketones is what puts a person at risk for DKA. 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 alcoholic ketoacidosis to prevent recurrence and long-term irreversible damage from alcohol abuse. Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated. Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care.

Diabetes and acetone-like breath

• If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream.
• If it is 240 mg/dL (milligrams/deciliter) or higher, use an over-the-counter ketone test kit to check your urine for ketones every four to six hours.
• If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized.
• In peripheral tissues, where NADH levels are lower, this lactate may be converted to pyruvate for metabolic needs.
• Your body typically produces ketone bodies when breaking down fat for energy, but their levels can rise significantly if you consume a lot of alcohol and don’t eat enough.

However, if an AKA patient is lethargic or comatose, an alternative cause should be sought. 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.

The Journal of Emergency Medicine

• Mortality specifically due to AKA has been linked to the severity of serum beta-hydroxybutyric acid in some studies.
• Lactic acidosis occurs when ethanol metabolism results in a high hepatic NADH/NAD ratio, diverting pyruvate metabolism towards lactate and inhibiting gluconeogenesis.
• They attributed this to the administration of therapy (intravenous dextrose) rather than the withdrawal of the toxin, ethanol.
• When the breath of a person with diabetes smells like acetone, they should check their blood sugar levels.

• The dextrose will also increase glycogen stores and diminish counterregulatory hormone levels.
• 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.
• Monitoring and correcting your glucose levels is another essential step, as it aids in preventing hypoglycemia.
• Apart from the risk of alcoholic ketoacidosis, alcohol can cause spikes in blood sugar.