An altered level of consciousness should prompt consideration of alternative diagnoses such as hypoglycaemia, seizures, sepsis, thiamine deficiency, or head injury. Arterial blood gas and biochemistry studies reveal a raised anion gap metabolic acidosis without evidence of lactic or diabetic ketoacidosis. Growth hormone, epinephrine, cortisol, and glucagon are all increased. Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. He was also placed on CIWA protocol while in the ED and received 1 mg of oral lorazepam. He was admitted to the internal medicine service for continued management.
- Without insulin, most cells cannot get energy from the glucose that is in the blood.
- Warfarin overdose was also considered, although the patient repeatedly denied this and reports he did not have access to his medications.
- Doctors base the diagnosis on the characteristic symptoms and their relation to alcohol abuse combined with laboratory test results that show increased amounts of ketones and acid in the bloodstream but normal or low blood glucose levels.
- Joining a local chapter of Alcoholics Anonymous may provide you with the support you need to cope.
- Read more due to vomiting, resulting in a relatively normal pH; the main clue is the elevated anion gap.
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). 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. Patients who appear significantly ill and those with positive ketones should have arterial blood gas and serum lactate measurements.
CLINICAL FEATURES
Going on a drinking binge when your body is in a malnourished state may cause abdominal pain, nausea, or vomiting. Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder. Patients improved rapidly (within 12 hours) with intravenous glucose and large amounts of intravenous saline, usually without insulin (although small amounts of bicarbonate were sometimes used). The prognosis for alcoholic ketoacidosis is good as long as it’s treated early.
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. 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. 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 syndrome of alcoholic ketoacidosis
He was hospitalized for three days for management of AKA and alcohol withdrawal, then discharged once tolerating oral intake and in good condition. He was seen three weeks later in the emergency department for a similar presentation. The greatest threats to patients with alcoholic ketoacidosis are marked contraction in extracellular fluid volume (resulting alcoholic ketoacidosis in shock), hypokalaemia, hypoglycaemia, and acidosis. If you have symptoms of alcoholic ketoacidosis, your doctor will perform a physical examination. They will also ask about your health history and alcohol consumption. If your doctor suspects that you’ve developed this condition, they may order additional tests to rule out other possible conditions.
- Your doctor and other medical professionals will watch you for symptoms of withdrawal.
- This test will provide information about your sugar levels to help determine whether you have diabetes.
- An elevated INR in a patient with chronic alcoholism may be due to vitamin K deficiency, which has not been previously reported.
- Pyruvate and lactate are then maintained in steady state at much higher levels than normal.
- Other vitamins and minerals, such as magnesium, are added to the saline solution.
If you have any additional complications during treatment, this will also affect the length of your hospital stay. 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. Alcoholic ketoacidosis is the buildup of ketones in the blood due to alcohol use. Ketones are a type of acid that form when the body breaks down fat for energy.