Alcoholic Ketoacidosis

Metabolic acidosis caused by increased production of ketone bodies with normal or low glucose levels resulting from the combined effects of alcohol and starvation on glucose metabolism

Aetiology

  • Most commonly occurs in malnourished individuals with AUD
  • Associated with recent episodes of binge drinking complicated by poor food intake, dehydration, and vomiting

Pathophysiology

Accumulation of ketone bodies as a result of:
  • Depleted glycogen stores in the liver from malnutrition/decreased carbohydrate intake
  • Increased lipolysis and FFA release
  • Volume depletion from e.g. vomiting, poor oral fluid intake which impaires renal perfusion and decreases ability to excrete ketone bodies

Clinical presentation

  • Nausea, vomiting
  • Abdominal pain
  • Increased respiratory rate
  • Dehydration

Investigations

  • Ketonaemia >3 mmol/L, or significant ketonuria (2+ on standard urine stick)
  • Bicarbonate usually <15 mmol/L or venous pH <7.3 in severe cases
  • Glucose usually normal, may be low

Management

  • IV pabrinex - high dose vitamins including thiamine to prevent Wernicke encephalopathy
  • IV fluid - 5% dextrose in 0.9% NaCl
  • IV anti-emetics
  • Insulin may be required on occasion

Further management

  • Address alcohol dependency