What is Alcoholic Ketoacidosis (Alcohol and Ketoacids)?
Alcoholic ketoacidosis, often referred to as AKA, is a medical condition that’s commonly seen in patients who have a long-term alcohol use disorder or those who frequently consume alcohol excessively in a short period (binge drink). This condition is typically found in chronic drinkers who are unable to eat or drink anything by mouth for a period of 1 to 3 days. These patients usually have a history of heavy drinking just before they start experiencing symptoms like persistent vomiting and abdominal pain, which make it difficult for them to consume anything.
What Causes Alcoholic Ketoacidosis (Alcohol and Ketoacids)?
Alcoholic ketoacidosis happens due to the patient’s inability to take in, process, and use glucose, or sugar, from their food. This is often because symptoms like vomiting and nausea stop them from getting enough nutrients from their food. Alcohol can further lower blood sugar levels by slowing down the body’s process of making new glucose.
Besides, being anxious or going through alcohol withdrawal can make it even harder for the patient to eat. If the only thing a patient is consuming is alcohol, not other nutrients, their body can start producing substances called ketones. This can lead to a condition called ketoacidosis, which involves high levels of ketones and acid in the blood. This typically happens when there’s no diabetes present.
Risk Factors and Frequency for Alcoholic Ketoacidosis (Alcohol and Ketoacids)
Alcoholic Ketoacidosis (AKA) tends to occur more frequently in communities where alcohol abuse is common. It can affect anyone regardless of their race or gender. AKA is usually observed in adults aged 20-60 years who have a prolonged history of alcohol abuse. In rare cases, AKA can occur even in individuals who are not regular drinkers, specifically after a heavy drinking session.
- Alcoholic Ketoacidosis (AKA) is more prevalent in places with high rates of alcohol abuse.
- It is not more common in one race or gender over another.
- AKA mainly affects adults aged 20-60 who frequently abuse alcohol.
- In rare cases, AKA can develop in individuals who are not regular drinkers after a heavy drinking session.
Signs and Symptoms of Alcoholic Ketoacidosis (Alcohol and Ketoacids)
Alcohol ketoacidosis, or AKA, is a condition often diagnosed through observation of several clinical signs. These include a quickened heart rate, dehydration, rapid breathing, abdominal pain, and agitation. It’s also common for patients to have a breath that smells of ketones, a byproduct of the body breaking down fat for energy.
The accelerated heart rate can be attributed to multiple factors:
- Several days of alcohol consumption, which suppresses a hormone that prevents excessive urination, leading to dehydration and an increased urinary frequency
- Nausea and vomiting resulting in decreased food and drink consumption 1 to 3 days before diagnosis
- Abdominal pain, which can also reduce food and drink intake and contribute to acidosis – an excessive accumulation of acid in the body, leading to increased respiratory rate and fluid loss.
Additionally, dehydration gives rise to symptoms like an increased heart rate and dryness in the mouth. Alcohol withdrawal and agitation can also contribute to the elevated heart rate.
The increase in breathing rate can be attributed to the imbalance of acid in the body, dehydration, withdrawal from alcohol, and abdominal pain. While abdominal discomfort is a common symptom, it can also be indicative of other alcohol-related conditions like gastritis or pancreatitis. If the pain is accompanied by increased tenderness or other signs of inflammation in the lining of the abdomen, further investigation may be necessary to identify possible alternative causes.
From a neurological perspective, patients often exhibit signs of agitation due to alcohol withdrawal coupled with nausea and vomiting. However, if the patient appears overly tired or falls into a coma, it may be a sign of other underlying issues that need attention.
Testing for Alcoholic Ketoacidosis (Alcohol and Ketoacids)
If you’re suspected of having a condition known as alcoholic ketoacidosis, your doctor will likely order several laboratory tests to help evaluate your health status.
A complete blood count or CBC is often requested. This test looks at different components of your blood. For instance, if you’re dehydrated, you might have more white blood cells, hemoglobin, and hematocrit than usual. Chronic alcohol users often have a larger average size of red blood cells, known as mean corpuscular volume or MCV.
Another test called a metabolic panel may also show some abnormalities. Dehydration and not eating enough can result in normal to low potassium levels. Bicarbonate levels, another component of your blood, could be low due to a condition called metabolic acidosis. You might also have higher than normal ratios of blood urea nitrogen to creatinine if you’re dehydrated. While blood sugar levels might be slightly high, they generally stay under 250 mg/dl and can even be within the normal range initially.
You could also have high levels of a substance called beta-hydroxybutyrate or B-OH in your bloodstream. If there’s more lactate than B-OH in your blood beyond a certain level, your doctor might look into other potential causes of acidosis. Also, your alcohol levels could be low or even missing altogether.
In an arterial blood gas or ABG analysis, your blood might show a pH that’s low or normal. Metabolic acidosis, leaving you with less bicarbonate, could also make an appearance in this test. If you’re able to, your body might be coping with these changes by increasing the pH level, or having a respiratory alkalosis.
Checking your urine or urinalysis might show a higher than normal specific gravity, indicating you could be dehydrated. Yet, if you’ve been drinking or have been able to handle liquid intake without much solid food in the past day, your urine’s specific gravity could be normal.
The nitroprusside test checks for something called ketonuria or having ketone bodies in the urine. Even when significant ketosis, or the presence of ketone bodies in your body, happens, the result might be weakly positive. That’s because this test can significantly underestimate the amount of beta-hydroxybutyrate in your body, which tends to be the major ketoacid in AKA cases. Your glucosuria, or the presence of glucose in the urine, would likely be missing, too.
Separately, an electrocardiogram or EKG will probably show a fast heart rate. In a dehydrated patient, it might even show abnormal heart rhythms like atrial fibrillation or atrial flutter, especially if the patient has a history of chronic alcohol abuse and alcoholic ketoacidosis. Nevertheless, an initial chest x-ray might not show any abnormalities.
Treatment Options for Alcoholic Ketoacidosis (Alcohol and Ketoacids)
When someone might have alcoholic ketoacidosis, or AKA, it’s crucial to diagnose them properly based on their symptoms. This includes giving them fluids, keeping an eye on their electrolyte levels, and treating them to prevent alcohol withdrawal symptoms. Doctors will also need to examine them and take a full medical history for a comprehensive diagnosis.
Diagnosis is the first step to treating AKA. When someone first goes to the hospital with potential AKA, their blood sugar level is checked first. After that, the main part of treatment is giving fluids to rehydrate. Usually, this fluid includes normal saline and dextrose. Dextrose, a type of sugar, is crucial because it helps break the cycle of ketone production, increases insulin secretion, builds up glycogen stores, and reduces the hormones that respond to low sugar levels. Before giving any sugar, however, it’s vital to give thiamine to prevent Wernicke’s encephalopathy, a severe neurological condition.
If someone has very low potassium levels, the administration of sugar can be held off until the potassium levels have normalized. Alcohol abuse and poor eating habits can also cause low levels of other electrolytes like magnesium and phosphate. Doctors will need to measure these levels and supplement them if they are found to be low.
Intravenous benzodiazepines may be given if there’s a risk of seizures due to impending alcohol withdrawal. Other medications like ondansetron or metoclopramide may be given to relieve nausea and vomiting.
What else can Alcoholic Ketoacidosis (Alcohol and Ketoacids) be?
When diagnosing alcoholic ketoacidosis, doctors consider several causes of high anion gap metabolic acidosis, which is a condition marked by the increased presence of acid in the body. These include:
- Diabetic ketoacidosis (a severe diabetes complication)
- Methanol toxicity (poisoning from a harmful alcohol type)
- Ethylene glycol toxicity (common in antifreeze poisonings)
- Uremia (a severe kidney disease complication)
- Lactic acidosis (an excessive amount of lactic acid in the body)
- Salicylate poisoning (overdose from aspirin or other salicylates)
Also, doctors must consider other diseases that often come along and precipitate, or trigger, alcohol ketoacidosis in patients, such as:
- Pancreatitis (inflammation of the pancreas)
- Peptic ulcer disease (when a part of the stomach or small intestine gets eaten away due to stomach acid)
- Acute cholecystitis (gallbladder inflammation)
- Acute mesenteric ischemia (poor blood flow to the intestines)
- Alcohol withdrawal.
Each of these conditions requires different tests and treatments, so it’s crucial to accurately diagnose the issue.
What to expect with Alcoholic Ketoacidosis (Alcohol and Ketoacids)
In general, patients with AKA (Alcoholic Ketoacidosis) usually have a good chance of recovery if the condition is recognized and treated early. However, if the diagnosis or treatment is delayed, the patient may suffer damage to body organs, like acute kidney failure.
The long-term outlook for patients diagnosed with AKA largely depends on how severe their alcohol abuse disorder is, rather than the AKA itself. One of the main reasons for health complications and death in patients with AKA is the failure to recognize concurrent diseases. These could potentially include conditions like acute pancreatitis, gastrointestinal bleeding, and alcohol withdrawal, which might also trigger AKA.
Mortality linked directly to AKA has been found to be related to the severity of a specific blood marker called beta-hydroxybutyric acid in some studies. This marker could be used to gauge the severity of the disease. Recognizing these high-risk patients can help determine the level of patient monitoring required to achieve the best possible health outcomes.
Possible Complications When Diagnosed with Alcoholic Ketoacidosis (Alcohol and Ketoacids)
Complications from Alcoholic Ketoacidosis (AKA) can happen if the condition isn’t diagnosed quickly, or if the patient’s body continues to produce ketones despite treatment. These complications could include severe dehydration leading to shock and even stoppage of the heart. To prevent these issues, it’s important to manage other related conditions, like imbalances in the body’s minerals and alcohol withdrawal, which could lead to seizures or a severe form of alcohol withdrawal called ‘delirium tremens.’
Often, long-term alcohol users may also have non-ischemic cardiomyopathy, a condition where the heart muscles don’t work as they should. This could become apparent as fluid accumulation in the lungs when treating AKA. To identify and prevent these complications from becoming severe, sufficient and regular monitoring of both patients’ physical symptoms and biochemical tests is crucial.
- Severe dehydration leading to shock
- Heart stoppage
- Imbalances in body’s minerals
- Seizures
- Delirium tremens
- Non-ischemic cardiomyopathy
- Fluid accumulation in the lungs
Preventing Alcoholic Ketoacidosis (Alcohol and Ketoacids)
After receiving treatment for AKA, patients should be given advice about alcohol abuse disorder. It’s also helpful to recommend them to programs that help with alcohol abuse rehabilitation. However, in many places, there aren’t enough local resources, and patients might not have good enough options for rehabilitation. This is why it’s key for the hospital staff who cared for the patient, to tell the patient’s regular doctor about the AKA diagnosis and any linked alcohol abuse disorder. This way, the patient can be matched with all possible resources to help them manage their alcohol abuse disorder.
