Alcoholic ketoacidosis is a condition that can happen when you’ve had a lot of alcohol and haven’t had much to eat or have been vomiting. When this happens, it can cause ketones, which are acids, to build up in your blood. If not treated quickly, alcoholic ketoacidosis may be life-threatening. When your body burns fat for energy, byproducts known as ketone bodies are produced. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream.
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Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. Lactic acidosis occurs when ethanol metabolism results in a high hepatic NADH/NAD ratio, diverting pyruvate metabolism towards lactate and inhibiting gluconeogenesis. In peripheral tissues, where NADH levels are lower, this lactate may be converted to pyruvate for metabolic needs. Pyruvate and lactate are then maintained in steady state at much higher levels than normal. This results in a decrease in circulating lactic acid and an increase in acetoacetate.
Differential Diagnosis
If your blood glucose level is elevated, your doctor may also perform a hemoglobin A1C (HgA1C) test. This test will provide information about your sugar levels to help determine whether you have diabetes. Someone who frequently drinks heavily already has an excessive buildup of ketones in the alcoholic ketoacidosis smell body. This can quickly become a problem because ketones are highly acidic, and an oversupply makes the body too acidic. And these high levels of acidity can lead to several other serious health issues. Jenkins et al2 suggested that alcohol induced mitochondrial damage might account for AKA.
The test is free, confidential, and no personal information is needed to receive the result. Wrenn et al found altered mental status in 15% of patients, attributable in all but one case to hypoglycaemia, severe alcohol intoxication, or infection. Fever was seen in only two patients, both with other likely underlying causes. Treatment may involve fluids (salt and sugar solution) given through a vein. You may get vitamin supplements to treat malnutrition caused by excess alcohol use.
What causes alcoholic ketoacidosis?
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Appropriately evaluate the patient for any life-threatening complications before a transfer is considered. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information.
