Alcoholic ketoacidosis PMC

Going on a drinking binge when your body is in a malnourished state may cause abdominal pain, nausea, or vomiting. Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder. Toxicity from methanol or ethylene glycol is an important differential diagnosis. Toxic metabolites of both substances result in severe metabolic acidosis with wide anion gap and wide osmolal gap.18 Neither, however, causes ketosis. Both cause abdominal pain, with marked central nervous system depression, but methanol toxicity results in visual impairment, while ethylene glycol toxicity results in crystalluria, oliguria, and renal failure. In general, the prognosis for a patient presenting with AKA is good as long as the condition is identified and treated early.

Calcium oxalate crystals in the urine also suggests alcoholic ketoacidosis poisoning. Lactic acid levels are often elevated because of hypoperfusion and the altered balance of reduction and oxidation reactions in the liver. Alcoholic ketoacidosis occurs when NAD is depleted by ethanol metabolism, resulting in inhibition of the aerobic metabolism in the Krebs cycle, depletion of glycogen stores, ketone formation, and lipolysis stimulation.

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Obtain intravenous access and administer fluid resuscitation for volume depletion and/or hypotension. With timely and aggressive intervention, the prognosis for a patient with AKA is good. The long-term prognosis for the patient is influenced more strongly by recovery from alcoholism. Tachypnea in the form of the Kussmaul respiration varieties is usually present when the pH is less than 7.2.

Ethanol metabolism results in NAD depletion manifesting as a higher ratio of the reduced form of nicotinamide adenine dinucleotide to NAD. When glycogen stores are depleted in a patient stressed by concurrent illness or volume depletion, insulin secretion is also suppressed. Under these same conditions, glucagon, catecholamine, and growth hormone secretion are all stimulated.

Alcoholic Ketoacidosis

Not all who binge drink have alcoholism or alcohol use disorder. Even so, people who are addicted to alcohol are more likely to experience alcohol-induced ketoacidosis, especially among people aged 20 to 60 years. Then change to 5% dextrose in half normal saline as maintenance until oral intake resumes. You can prevent alcoholic ketoacidosis by limiting your alcohol intake. You can learn how to reduce your alcohol intake or eliminate it altogether. Joining a local chapter of Alcoholics Anonymous may provide you with the support you need to cope.

  • As rehydration progresses and adequate renal function is established, consider electrolyte replacement, giving particular attention to potassium and magnesium.
  • Suspect alcoholic ketoacidosis in any patient with recent binge drinking and an elevated anion gap.
  • Urine tests for ketones may be falsely negative or only trace positive in alcoholic ketoacidosis.
  • Alcohol-induced disturbances in electrolyte and acid base homeostasis.

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