This ketoacidosis is similar to the ketoacidosis that occurs in diabetes except that, unlike in diabetic ketoacidosis, blood glucose levels are low. This is why diagnosis and subsequent treatment can sometimes be challenging, but it’s crucial to receive a proper and timely diagnosis to obtain the correct treatment. The patient should have blood glucose checked on the initial presentation. The next important step in the management of AKA is to give isotonic fluid resuscitation. Dextrose is required to break the cycle of ketogenesis and increase insulin secretion. The dextrose will also increase glycogen stores and diminish counterregulatory hormone levels.
Differential Diagnosis
Alcoholic ketoacidosis (AKA) is defined by metabolic acidosis and ketosis in a patient with alcohol use. This is a common presentation in the emergency department (ED) and requires targeted therapies. Alcoholic ketoacidosis is a complication of alcohol use and starvation that causes excess acid in the bloodstream, resulting in vomiting and abdominal pain.
Complicated Acidosis Presentations: When Is Diabetic Ketoacidosis Not Diabetic Ketoacidosis? A Case Series
Intravenous benzodiazepines can be administered based on the risk of seizures from impending alcohol withdrawal. Antiemetics such as ondansetron or metoclopramide may also be given to control nausea and vomiting. It can be helpful to understand the basic guidelines for alcohol consumption so you can determine whether you are drinking above recommended levels and engaging in potentially harmful alcohol use. This narrative review evaluates the pathogenesis, diagnosis, and management of AKA for emergency clinicians. Treatment may involve fluids (salt and sugar solution) given through a vein.
Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment
In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. Several mechanisms are responsible for dehydration, including protracted vomiting, decreased fluid intake, and inhibition of antidiuretic hormone secretion by ethanol. Volume alcoholic ketoacidosis depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels. Arrange follow-up to evaluate patients after the resolution of symptoms, in order to detect other complications of chronic alcohol abuse.
- Similar symptoms in a person with alcohol use disorder may result from acute pancreatitis, methanol (wood alcohol) or ethylene glycol (antifreeze) poisoning or diabetic ketoacidosis.
- If your doctor suspects that you’ve developed this condition, they may order additional tests to rule out other possible conditions.
- Joining a local chapter of Alcoholics Anonymous may provide you with the support you need to cope.
- Growth hormone, epinephrine, cortisol, and glucagon are all increased.
- If indicated, provide follow-up with AKA patients to assess the problem of alcohol abuse.
- The absence of hyperglycemia makes diabetic ketoacidosis improbable.
- He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.
- Seeking help as soon as symptoms arise reduces your chances of serious complications.
- He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world.
Without insulin, your cells won’t be able to use the glucose you consume for energy. Exclude other causes of autonomic hyperactivity and altered mental status. https://ecosoberhouse.com/ If the diagnosis of alcohol withdrawal syndrome is established, consider the judicious use of benzodiazepines, which should be titrated to clinical response.
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