Alcoholic Ketoacidosis

by Chris Nickson, Last updated December 17, 2012

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

About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

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