Alcoholic ketoacidosis

Question 1

What is alcoholic ketoacidosis?

Answer 1

Metabolic acidosis caused by increased production of ketone bodies with normal or low glucose levels resulting from the combined effects of alcohol and starvation on glucose metabolism

Question 2

How does alcoholic ketoacidosis most commonly affect?

Answer 2

Malnourished individual with alcohol use disorder (AUD), associated with recent episodes ofbinge drinkingcomplicated by poor food intake, dehydration, and vomiting

Question 3

What causes a build up of ketone bodies in alcoholic ketoacidosis?

Answer 3

• Depleted glycogen stores in the liver from malnutrition/decreased carbohydrate intake
• Increased lipolysis and FFA release
• Volume depletion from e.g. vomiting, poor oral fluid intake which impaires renal perfusion and decreases ability to excrete ketone bodies

Question 4

How does alcoholic ketoacidosis present?

Answer 4

• Nausea, vomiting
• Abdominal pain
• Increased respiratory rate
• Dehydration

Question 5

What will investigation show in alcoholic ketoacidosis?

Answer 5

• Ketonaemia >3 mmol/L, or significant ketonuria (2+ on standard urine stick)
• Bicarbonate usually <15 mmol/L or venous pH <7.3 in severe cases
• Glucose usually normal, may be low

Question 6

How is alcoholic ketoacidosis managed?

Answer 6

• IV pabrinex - high dose vitamins including thiamine to prevent Wernicke encephalopathy
• IV fluid - 5% dextrose in 0.9% NaCl
• IV anti-emetics
• Insulin may be required on occasion
• Address alcohol dependency