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Alcoholic Ketoacidosis

What is alcoholic ketoacidosis?

Key points

  1. Ketoacidosis occurs when you ingest something that is metabolized or turned into an acid.
  2. Excessive alcohol consumption can lead to alcoholic ketoacidosis, as well as malnutrition.
  3. Common symptoms of alcoholic ketoacidosis include abdominal pain, fatigue, vomiting, and dehydration.

Cells need glucose (sugar) and insulin to function properly. Glucose comes from the food you eat, and insulin is produced by the pancreas. When you drink alcohol, your pancreas may stop producing insulin for a short time. Without insulin, your cells won’t 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, byproducts known as ketone bodies are produced. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream. This buildup of ketones can produce a life-threatening condition known as ketoacidosis.

Ketoacidosis, or metabolic acidosis, occurs when you ingest something that is metabolized or turned into an acid. This condition has a number of causes, including:

  • large doses of aspirin
  • shock
  • kidney disease
  • abnormal metabolism

In addition to general ketoacidosis, there are several specific types. These types include:

  • alcoholic ketoacidosis, which is caused by excessive consumption of alcohol
  • diabetic ketoacidosis (DKA), which mostly develops in people with type 1 diabetes
  • starvation ketoacidosis, which occurs most often in women who are pregnant, in their third trimester, and experiencing excessive vomiting

Each of these situations increases the amount of acid in the system. They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones.

What causes alcoholic ketoacidosis?

Causes

Alcoholic ketoacidosis develops 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).

People who drink large quantities of alcohol may not eat regularly. They may also vomit as a result of drinking too much. Not eating enough or vomiting can lead to periods of starvation. This further reduces the body’s insulin production.

If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis. This can occur as soon as one day after a drinking binge.

Read more: Nutritional deficiencies (malnourishment) »

What are the symptoms of alcoholic ketoacidosis?

Symptoms

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
  • agitation and confusion
  • decreased alertness or coma
  • fatigue
  • slow 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.

Someone with alcoholic ketoacidosis may also have other conditions that are associated with alcohol abuse. These may include:

  • pancreatitis
  • liver disease
  • kidney disease
  • ulcers
  • ethylene glycol poisoning

These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis.

How is alcoholic ketoacidosis diagnosed?

Diagnosis

If you have symptoms of alcoholic ketoacidosis, your doctor will perform a physical examination. They will also ask about your health history and alcohol consumption. If your doctor suspects that you’ve developed this condition, they may order additional tests to rule out other possible conditions. After these test results are in, they can confirm the diagnosis.

Tests may include the following:

  • amylase and lipase tests, to monitor the functioning of your pancreas and check for pancreatitis
  • arterial blood gas test, to measure your blood’s oxygen levels and acid/base balance
  • anion gap calculation, which measures sodium and potassium levels
  • blood alcohol test
  • blood chemistry panel (CHEM-20), to get a comprehensive look at your metabolism and how well it’s functioning
  • blood glucose test
  • blood urea nitrogen (BUN) and creatinine tests, to determine how well your kidneys are functioning
  • serum lactate test, to determine levels of lactate in the blood (high lactate levels can be a sign of lactic acidosis, a condition that usually indicates that the body’s cells and tissues are not receiving enough oxygen)
  • urine test for ketones

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.

Learn more: All about the hemoglobin A1C test »

How is alcoholic ketoacidosis treated?

Treatment

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. They will also give you fluids intravenously. You may receive vitamins and nutrients to help treat malnutrition, including:

  • thiamine
  • potassium
  • phosphorus
  • magnesium

Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care. The length of your hospital stay depends on the severity of the alcoholic ketoacidosis. It also depends on how long it takes to get your body regulated and out of danger. If you have any additional complications during treatment, this will also affect the length of your hospital stay.

What are the complications of alcoholic ketoacidosis?

Complications

One complication of alcoholic ketoacidosis is alcohol withdrawal. Your doctor and other medical professionals will watch you for symptoms of withdrawal. If you have severe symptoms, they may give you medication. Alcoholic ketoacidosis may lead to gastrointestinal bleeding.

Other complications may include:

  • psychosis
  • coma
  • pancreatitis
  • pneumonia
  • encephalopathy (a brain disease that can cause memory loss, personality changes, and muscle twitching, though this is uncommon)

What is the long-term outlook for alcoholic ketoacidosis?

Outlook

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.

Your prognosis will be impacted by the severity of your alcohol use and whether or not you have liver disease. Prolonged used of alcohol can result in cirrhosis, or permanent scarring of the liver. Cirrhosis of the liver can cause exhaustion, leg swelling, and nausea. It will have a negative effect on your overall prognosis.

How can I prevent alcoholic ketoacidosis?

Prevention

You can prevent alcoholic ketoacidosis by limiting your alcohol intake. If you are addicted to alcohol, seek professional help. 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. You should also follow all of your doctor’s recommendations to ensure proper nutrition and recovery.

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