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Alcoholic ketoacidosis
Last reviewed: 19.11.2021
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Alcoholic ketoacidosis is a metabolic complication of alcohol consumption and fasting, characterized by hyperketonemia and anionic disorders with metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and pain in the abdomen. Diagnosis is based on anamnesis and the definition of ketoacidosis in the absence of hyperglycemia. Treatment consists of intravenous injection of physiological solution and dextrose.
[Causes of the alcoholic Ketoacidosis
Alcoholic ketoacidosis is due to the combined effects of alcohol and fasting on the metabolism of glucose. Alcohol reduces hepatic gluconeogenesis and leads to a decrease in insulin secretion, an increase in lipolysis, a violation of the oxidation of fatty acids and subsequent ketogenesis. The level of counterregulatory hormones is increased, further inhibition of insulin secretion can occur. Plasma glucose levels are usually normal or reduced, but sometimes mild hyperglycemia can occur.
Usually excessive alcohol consumption leads to vomiting and stopping drinking alcohol or food for 24 hours or more. During this period of fasting, vomiting continues, there is pain in the abdomen, leading to the patient's medical care. Pancreatitis can develop.
Diagnostics of the alcoholic Ketoacidosis
Diagnosis requires a lot of attention, the absence of hyperglycemia makes the diagnosis of diabetic ketoacidosis impossible. In routine laboratory studies, pronounced anionic disorders and metabolic acidosis, ketonemia, low levels of potassium, magnesium and phosphorus are detected. The detection of acidosis can be complicated by concomitant metabolic alkalosis, which developed as a result of vomiting. Often, the levels of lactic acid are increased due to a disbalance in the processes of oxidation and reduction in the liver.
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Treatment of the alcoholic Ketoacidosis
Treatment of alcoholic ketoacidosis begins with intravenous administration of a 5% solution of dextrose in 0.9% saline with the addition of thiamine and other water-soluble vitamins and K, if necessary. Ketoacidotic and gastrointestinal symptoms are usually quickly stopped. The use of insulin is necessary only if suspected atypical diabetic ketoacidosis or when developing hyperglycemia> 300 mg / dl.