Alcoholic Ketoacidosis

OVERVIEW

• rare
• small proportion of chronic ethanol abusers
• relatively benign if patients given IV dextrose and fluids
• unclear aetiology
  ? starvation, dehydration, excess acetate production, altered redox state, hormonal imbalances, genetic predisposition

HISTORY

• alcohol binge -> when blood alcohol level declining + not eating
• anorexia
• nausea
• epigastric pain
• vomiting

EXAMINATION

• clear sensorium
• acetone odour
• tachypnoea or Kussmaul respiration (if marked acidaemia)
• tachycardia
• volume depletion

INVESTIGATIONS

• ABG: metabolic acidosis, ketonaemia, ketonuria (may have metabolic alkalosis if has severe vomiting)
• normal, low or slightly high blood glucose
• ratio of beta-hydroxybutyerate to acetoacetate seen in alcoholic is higher than seen in DKA

MANAGEMENT

• exclude other causes for metabolic acidosis (AKA is a diagnosis of exclusion)
• give fluid + dextrose
• monitor closely for refeeding syndrome