Alcoholic ketoacidosis

Question 1

Pathophysiology?

Answer 1

Alcoholic ketoacidosis is a non-diabetic euglycaemic form of ketoacidosis. It occurs in people who regularly drink large amounts of alcohol. Often alcoholics will not eat regularly and may vomit food that they do eat, leading to episodes of starvation. Once the person becomes malnourished, after an alcohol binge the body can start to break down body fat, producing ketones. Hence the patient develops a ketoacidosis.

Question 2

Typical presentation?

Answer 2

• Metabolic acidosis
• Elevated anion gap
• Elevated serum ketone levels
• Normal or low glucose concentration

Question 3

Treatment?

Answer 3

Infusion of saline and thiamine

Question 4

Why is thiamine in the treatment regime?

Answer 4

Thiamine is required to avoid Wernicke encephalopathy or Korsakoff psychosis.