Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment

This drop in blood sugar causes your body to decrease the amount of insulin it produces. Your cells need insulin to use the glucose in your blood for energy. If they can’t use glucose because there’s not enough insulin, your body switches to another method to get energy — breaking down fat cells. These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis.

Signs and symptoms of alcoholic ketoacidosis

Cirrhosis of the liver can cause exhaustion, leg swelling, and nausea. If you develop any of these symptoms, seek emergency medical attention. Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you’re taking certain medications that also depress the brain’s function. Alcohol use disorder can include periods of being drunk (alcohol intoxication) and symptoms of withdrawal.

How Lactic Acidosis Is Diagnosed

Failure to make the diagnosis can result in severe metabolic abnormalities, acidosis, and shock. If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors. Seeking help as soon as symptoms arise reduces your chances of serious complications. Treatment for alcohol addiction is also necessary to prevent a relapse of alcoholic ketoacidosis. Types of shock include septic (widespread infection), hypovolemic (loss of blood/fluid), and cardiogenic (heart malfunctioning) shock. In addition, blood lactate levels should be tracked (if elevated) and used as a resource when choosing therapies to optimize chances for a full recovery.

Differential Diagnosis

Take our free, 5-minute alcohol abuse self-assessment below if you think you or someone you love might be struggling with alcohol abuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an alcohol use disorder. The test is free, confidential, and no personal alcoholic ketoacidosis information is needed to receive the result. Alcoholic ketoacidosis can develop when you drink excessive amounts of alcohol for a long period of time. Excessive alcohol consumption often causes malnourishment (not enough nutrients for the body to function well). There are many causes of lactic acidosis, and sometimes the two types overlap.

What are the symptoms of alcoholic ketoacidosis?

Breathing tends to become deep and rapid as the body attempts to correct the blood’s acidity. 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. The doctor must exclude these other causes before diagnosing alcoholic ketoacidosis.

• They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones.
• Diagnosis is by history and findings of ketoacidosis without hyperglycemia.
• Hypovolemic shock is another frequent cause of type A lactic acidosis.
• The patient is well-known to the department for alcohol-related visits and continues to drink daily.

These high lactate levels may result from increased cell production, decreased clearance (mainly within the liver), or some combination. Alcoholic ketoacidosis most commonly happens in people who have alcohol use disorder and chronically drink a lot of alcohol. But it can happen after an episode of binge drinking in people who do not chronically abuse alcohol. Alcoholic ketoacidosis doesn’t occur more often in any particular race or sex. The prognosis for alcoholic ketoacidosis is good as long as it’s treated early.

• In general, the prognosis for a patient presenting with AKA is good as long as the condition is identified and treated early.
• If your blood glucose level is elevated, your doctor may also perform a hemoglobin A1C (HgA1C) test.
• Lactate is a natural fuel source for cells and is a product of anaerobic metabolism, a process whereby cells break down glucose (sugar) for energy in the presence of low oxygen levels.
• Both steps require the reduction of nicotinamide adenine dinucleotide (NAD+) to reduced nicotinamide adenine dinucleotide (NADH).
• With timely and aggressive intervention, the prognosis for a patient with AKA is good.

However, after adequate treatment, it is equally essential to refer the patient to alcohol abuse rehabilitation programs to prevent recurrence and long-term irreversible damage from alcohol abuse. Laboratory analysis plays a major role in the evaluation of a patient with suspected alcoholic ketoacidosis. Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated.

• Detection of acidosis may be complicated by concurrent metabolic alkalosis due to vomiting, resulting in a relatively normal pH; the main clue is the elevated anion gap.
• An elevated INR in a patient with chronic alcoholism may be due to vitamin K deficiency, which has not been previously reported.
• The test is free, confidential, and no personal information is needed to receive the result.
• If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis.
• Alcohol dehydrogenase (ADH), a cytosolic enzyme, metabolizes alcohol to acetaldehyde in hepatocytes.
• This typically occurs 8 to 16 hours after the initiation of treatment.2 Alcohol withdrawal in these patients should be aggressively managed with intravenous benzodiazepines.