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
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