Alcoholic Ketoacidosis: Mind the Gap, Give Patients What They Need EMRA
Free fatty acids are removed by the liver, where they primarily undergo oxidation to hydroxybutyric acid and acetoacetate and subsequently are reesterified to triglyceride. Decreased insulin and elevated glucagon, cortisol, catecholamine, and growth hormone levels can increase the rate of ketogenesis. This article explores lactic acidosis, including types, causes, symptoms, diagnosis, and treatment. It will also briefly review what a high lactate level means regarding potential medical outcomes.
- On arrival, he is tachycardic and tachypneic, and physical examination findings include dry mucous membranes, decreased sakin turgor, epigastric tenderness, and a tremor in both hands.
- You should also follow all of your doctor’s recommendations to ensure proper nutrition and recovery.
- In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis.
- You might not recognize how much you drink or how many problems in your life are related to alcohol use.
- When this happens, it can cause ketones, which are acids, to build up in your blood.
Alcoholic Ketoacidosis: Symptoms, Causes, and Risks
During starvation, there is a decrease in insulin secretion and an increase in the production of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone. Hormone-sensitive lipase is normally inhibited by insulin, and, when insulin levels fall, lipolysis is up-regulated, causing release of free fatty acids from peripheral adipose tissue. Generally, the physical findings relate to volume depletion and chronic alcohol abuse. Typical characteristics of the latter may include rhinophyma, tremulousness, hepatosplenomegaly, peripheral neuropathy, gynecomastia, testicular atrophy, and palmar erythema.
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Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment
Laboratory studies show a serum bicarbonate of 10 mEq/L, an anion gap of 30, a serum glucose of 95 mg/dL, a lactic acidosis with pH 7.2, hypophosphatemia, and trace ketonuria. He denies a history of diabetes mellitus, ingestion of any toxic alcohols, or recent illness. Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain.
- Take our free, 5-minute alcohol abuse self-assessment below if you think you or someone you love might be struggling with alcohol abuse.
- Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care.
- If you develop any of these symptoms, seek emergency medical attention.
When to Contact a Medical Professional
On hospital day three, the patient was discharged home with outpatient services for his alcohol use disorder. A 49-year-old male with a history of alcohol abuse presents to the ED with complaints of generalized abdominal pain and vomiting for the last 36 hours. The patient alcoholic ketoacidosis is well-known to the department for alcohol-related visits and continues to drink daily. On arrival, he is tachycardic and tachypneic, and physical examination findings include dry mucous membranes, decreased sakin turgor, epigastric tenderness, and a tremor in both hands.
Differential Diagnosis
- There are many causes of lactic acidosis, and sometimes the two types overlap.
- In contrast to diabetic ketoacidosis, the predominant ketone body in AKA is β-OH.
- With cardiogenic shock, the heart fails to pump blood to vital organs.
Other ways to get help include talking with a mental health professional or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group. Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking — a pattern of drinking where a male has five or more drinks within two hours or a female has at least four drinks within two hours. 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.
- The treatment of type B lactic acidosis is geared towards the specific cause.
- Profound dehydration can culminate in circulatory collapse and/or lactic acidosis.
- This can occur as soon as one day after a drinking binge, depending on nutritional status, overall health status, and the amount of alcohol consumed.
- An intervention from loved ones can help some people recognize and accept that they need professional help.
Impact on your health
What Causes Lactic Acidosis?
