Antiemetics such as ondansetron or metoclopramide may also be given to control nausea and vomiting. People who drink large quantities of alcohol may not eat regularly. Alcoholic ketoacidosis can develop when you drink excessive amounts of alcohol for a long period of time.

Managing Alcoholic Ketoacidosis: Treatment Strategies

These include acute pancreatitis, gastrointestinal bleeding, and alcohol withdrawal. Mortality specifically due to AKA has been linked to the severity of serum beta-hydroxybutyric acid in some studies. In general, exogenous insulin is contraindicated in the treatment of AKA, because it may cause life-threatening hypoglycemia in patients with depleted glycogen stores.

• If you develop any of these symptoms, seek emergency medical attention.
• Depending on how bad their alcohol abuse has been or if medically-assisted alcohol detox will be needed for withdrawal symptoms, entering into a treatment center may be a necessary option.
• These include acute pancreatitis, gastrointestinal bleeding, and alcohol withdrawal.
• Fluid resuscitation, carbohydrate administration, and thiamine supplementation are the mainstays of treatment in alcoholic ketoacidosis (AKA).
• Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder.
• If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors.

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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 litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. Patients generally do not need to be transferred to special facilities. Appropriately evaluate the patient for any life-threatening complications before a transfer is considered.

Treatment of Severe Acidosis

Fluids alone do not correct AKA as quickly as fluids and carbohydrates together. Thiamine supplementation should also be given upon initiation of dextrose. Elevated cortisol levels can increase fatty acid mobilization and ketogenesis.

The condition is further exacerbated by lipolysis, which releases free fatty acids into the bloodstream, and intravascular volume contraction. Several mechanisms are responsible for dehydration, including protracted vomiting, decreased fluid intake, and inhibition of antidiuretic hormone secretion by ethanol. Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels.

• Strongly consider providing thiamine supplementation to patients with alcohol dependence even without signs of thiamine deficiency.
• If your blood glucose level is elevated, your doctor may also perform a hemoglobin A1C (HgA1C) test.
• Patients are generally dehydrated, and serum glucose can be low, normal, or mildly elevated.
• Moreover, volume depletion increases the concentration of counter-regulatory hormones, further stimulating lipolysis and ketogenesis.
• American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information.

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Fluid resuscitation, carbohydrate administration, and thiamine supplementation are the mainstays of treatment in alcoholic ketoacidosis (AKA). During starvation, there is a decrease in insulin secretion and an increase in the production of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone. Hormone-sensitive lipase is normally alcoholic ketoacidosis inhibited by insulin, and, when insulin levels fall, lipolysis is up-regulated, causing release of free fatty acids from peripheral adipose tissue. People with this condition are usually admitted to the hospital, often to the intensive care unit (ICU). The condition is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids.

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Exclude other causes of autonomic hyperactivity and altered mental status. If the diagnosis of alcohol withdrawal syndrome is established, consider the judicious use of benzodiazepines, which should be titrated to clinical response. For patient education information, see the Mental Health and Behavior Center, as well as Alcoholism and Alcohol Intoxication.

Alcoholic ketoacidosis: a cause of sudden death of chronic alcoholics