Alcoholic ketoacidosis

Question 1

Define 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

Who is most at risk of developing alcoholic ketoacidosis (AKA)?

Answer 2

Malnourished individuals with alcohol use disorder (AUD)

Question 3

What common situation triggers AKA?

Answer 3

Binge drinking followed by poor food intake, dehydration, and vomiting

Question 4

How does AKA differ from DKA in terms of glucose levels?

Answer 4

Glucose is normal or low in AKA, whereas in DKA it is high

Question 5

What are the key symptoms of AKA?

Answer 5

(1) Nausea
(2) vomiting
(3) abdominal pain
(4) dehydration
(5) increased respiratory rate

Question 6

Why do patients with AKA breathe rapidly?

Answer 6

Metabolic acidosis (from ketones) leads to compensatory respiratory alkalosis (Kussmaul breathing)

Question 7

What key blood test confirms AKA?

Answer 7

Ketonaemia >3 mmol/L or ketonuria (≥2+ on urine dipstick)

Question 8

What happens to bicarbonate and pH in AKA?

Answer 8

Bicarbonate <15 mmol/L and venous pH <7.3 (in severe cases)

Question 9

How do blood glucose levels in AKA compare to DKA?

Answer 9

Normal or low in AKA; high in DKA

Question 10

What is the first-line treatment for AKA?

Answer 10

IV Pabrinex

Question 11

What IV fluids are given in AKA?

Answer 11

5% dextrose in 0.9% NaCl

Question 12

Why is dextrose used instead of insulin in AKA?

Answer 12

Dextrose stimulates endogenous insulin secretion, which stops ketone production naturally