Alcoholic Ketoacidosis: A Silent Killer

The presence of a mixed alcoholic ketoacidosis may also be present as significant vomiting can cause metabolic alkalosis. Complete blood count – The white blood cell count , hemoglobin, and hematocrit levels may be elevated in a dehydrated patient. An elevated mean corpuscular volume is often seen in patients with chronic alcohol use disorder. Oxidation of ethanol to acetaldehyde also produces molecules of NADH, which suppress gluconeogenesis through negative feedback, further exacerbating hypoglycemia and the production of ketones.

What happens if alcoholic ketoacidosis is left untreated?

Alcoholic ketoacidosis is a condition that can happen when you've had a lot of alcohol and haven't had much to eat or have been vomiting. When this happens, it can cause ketones, which are acids, to build up in your blood. If not treated quickly, alcoholic ketoacidosis may be life-threatening.

Significant acidosis may be seen because of a combination of dehydration and a metabolic redox state, which favors pyruvate over lactate. Lactic acidosis occurs when ethanol metabolism results in a high hepatic NADH/NAD ratio, diverting pyruvate metabolism towards lactate and inhibiting gluconeogenesis. In peripheral tissues, where NADH levels are lower, this lactate may be converted to pyruvate for metabolic needs.

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Efficient and timely management can lead to enhanced patient outcomes in patients with AKA. However, after adequate treatment, it is equally essential to refer the patient to alcohol abuse rehabilitation programs to prevent recurrence and long-term irreversible damage from alcohol abuse. Laboratory analysis plays a major role in the evaluation of a patient with suspected alcoholic ketoacidosis. Dehydration causes an elevated heart rate and dry mucous membranes.

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The reversal of ketosis and vigorous rehydration are central in the management of AKA. In addition to isotonic fluid replacement, dextrose-containing intravenous fluids are needed. Intravenous dextrose-containing fluid infusions should be stopped once the bicarbonate levels have reached mEq/L and the patient is tolerating oral intake.

What are the symptoms of alcoholic ketoacidosis?

He was also placed on CIWA protocol while in the ED and received 1 mg of oral lorazepam. He was admitted to the internal medicine service for continued management. By hospital day two, the patient’s INR normalized to therapeutic range and his warfarin was restarted.


On hospital day three, the patient was discharged home with outpatient services for his alcohol use disorder. Although patients with alcoholic ketoacidosis have depleted glycogen stores, their serum glucose level is often within the normal range. An elevated lactic acid level and elevated osmolar gap due to acetone are typically seen.