Alcoholic Ketoacidosis

Written by Darla Burke
Medically Reviewed by George Krucik, MD

What Is Alcoholic Ketoacidosis?

Cells need glucose (sugar) and insulin to function properly. Glucose comes from the food you eat, and the pancreas produces insulin. When you drink alcohol, your pancreas may stop producing insulin for a short time. Without insulin, your cells will not be able to use the glucose you consume for energy. To get the energy you need, your body will start to burn fat.

When your body burns fat for energy, by-products known as ketones bodies are produced. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream. This buildup of ketone can produce a life-threatening condition known as ketoacidosis. Ketoacidosis caused by the consumption of alcohol is known as alcoholic ketoacidosis. Ketoacidosis can also develop in patients who have diabetes. This condition is known as diabetic ketoacidosis, or DKA.

What Causes Alcoholic Ketoacidosis?

Alcoholic ketoacidosis develops when you drink excessive amounts of alcohol for long periods. People who develop this condition are often malnourished as well.

Excessive alcohol consumption can cause malnourishment. People who drink large quantities of alcohol may not eat regularly. They may also vomit as a result of drinking so much. Not eating enough and/or vomiting leads to periods of starvation in which the body further reduces its insulin production. Therefore, to get energy, the body begins to break down fats, leading to ketoacidosis.

What Are the Symptoms of Alcoholic Ketoacidosis?

The symptoms of alcoholic ketoacidosis will vary based on how much alcohol you have consumed. Symptoms will also depend on the amount of ketones in your bloodstream. Common symptoms of alcoholic ketoacidosis include:

  • abdominal pain
  • changes in mental state, such as agitation and confusion
  • decreased alertness or coma
  • fatigue
  • sluggish movement
  • irregular, deep, and rapid breathing (Kussmaul’s sign)
  • loss of appetite
  • nausea and vomiting
  • symptoms of dehydration, such as dizziness (vertigo), lightheadedness, and thirst

If you develop any of these symptoms, seek emergency medical attention. Alcoholic ketoacidosis is a life-threatening illness.

How Is Alcoholic Ketoacidosis Diagnosed?

Your doctor can diagnose alcoholic ketoacidosis. If you have symptoms of this disorder, your doctor will perform a physical examination. He or she will also ask about your health history and alcohol consumption. If your doctor suspects that you’ve developed alcoholic ketoacidosis, he or she may order additional tests to confirm the diagnosis.

Tests may include the following:

  • arterial blood gases: to measure your blood’s oxygen levels and acid/base balance
  • blood alcohol level: to measure the amount of alcohol in your blood
  • blood chemistries (CHEM-20): to get a comprehensive look at your metabolism and how well it’s functioning
  • toxicology (poison) screening: a blood or urine test to check the type and amount of drugs in your system
  • electrolytes: to determine whether you have an electrolyte imbalance; electrolyte balance is necessary for healthy functioning of your cells and organs
  • BUN and creatinine: to determine how well your kidneys are functioning
  • amylase and lipase: to monitor the functioning of your pancreas
  • serum lactate: to determine levels of lactate in the blood; high lactate levels can be a sign of lactic acidosis. Lactic acidosis usually means that the body’s cells and tissues are not receiving enough oxygen.
  • urine ketones: ketones can show up in the urine
  • glucose levels

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. If you have diabetes, you may need additional treatment.

How Is Alcoholic Ketoacidosis Treated?

Treatment for alcoholic ketoacidosis is typically administered in the emergency room. Your doctor will monitor your vital signs, including your heart rate, blood pressure, and breathing. He or she will also give you fluids through a vein in your arm (intravenously). You may be given vitamins and nutrients to help treat malnutrition. Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care.

What Is the Long-Term Outlook for Alcoholic Ketoacidosis?

If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors. Seeking prompt help when symptoms arise reduces your chances of developing severe complications. Complications may include encephalopathy (a brain disease that can cause memory loss, personality changes, and muscle twitching), psychosis, or coma.

Seeking help for your alcohol addiction is also necessary to prevent a relapse of this condition. Alcoholics Anonymous is a helpful organization for those suffering from alcoholism.

Your prognosis will also be impacted by the severity of your alcohol use and the presence or absence of liver disease. Prolonged used of alcohol can cause scarring of the liver (cirrhosis). This condition is permanent and will impact your health. Cirrhosis of the liver can cause exhaustion, leg swelling, and nausea. If you have developed cirrhosis, your prognosis will not be as good.

Additional health problems may also occur as a complication of alcoholic ketoacidosis. Complications include:

  • gastrointestinal bleeding
  • inflammation of the pancreas (pancreatitis)
  • pneumonia

If you develop any of these problems, your long-term outlook will not be as positive.

How Can I Prevent Alcoholic Ketoacidosis?

Limiting your alcohol intake can prevent alcoholic ketoacidosis. If you suffer from addiction, you should seek help to reduce or to avoid alcohol consumption. Joining a local chapter of Alcoholics Anonymous can provide you with support to cope with your alcohol problem.

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