Definition
Alcoholic ketoacidosis is a metabolic complication resulting from the combination of the effects of alcohol intake and prolonged fasting. This condition is characterized by hyperketonemia and acidosis with high anion gap, without significant hyperglycemia.
In alcoholic and malnourished patients, therefore, alcohol intake reduces hepatic gluconeogenesis and leads to a decrease in insulin secretion, increased lipolysis, reduced oxidation of fatty acids and consequent ketogenesis.
Most common symptoms and signs *
- Acute abdomen
- Halitosis
- Anorexia
- ketone
- Dehydration
- Abdominal pain
- Hyperglycemia
- Hyperhidrosis
- Hypoglycemia
- undernourishment
- Orthostatic hypotension
- hypovitaminosis
- Nausea
- Tachycardia
- tachypnoea
- Dizziness
- He retched
Further indications
Inordinate alcohol intake typically leads to nausea and vomiting. These symptoms induce the subject to interrupt the ingestion of food for a period of time equal to or greater than 24 hours. During this fasting, repeated episodes of vomiting continue to occur and diffuse abdominal pain (moderate or intense) and orthostatic vertigo occur.
Blood sugar is usually normal, low or moderately high. The alcoholic ketoacidosis also determines the smell of ketones in the breath (similar to rotten apples), tachycardia, tachypnea (Kussmaul breath), dehydration and profuse sweating. Furthermore, pancreatitis can occur.
The diagnosis arises with the anamnesis and the finding of ketoacidosis in the absence of a high alcohol level or a concomitant hyperglycemia. Typical laboratory findings include metabolic acidosis with high anion gap, ketonemia and low levels of potassium and magnesium.
The diagnosis requires great caution, as similar symptoms can derive from acute pancreatitis, methanol or ethyl glycol poisoning, liver disease or diabetic ketoacidosis.
Treatment includes intravenous infusion of 5% dextrose in physiological solution and electrolyte recovery (K and Mg). Furthermore, as necessary, thiamine and other water-soluble vitamins can be administered to prevent the development of Wernicke's encephalopathy or Korsakoff's psychosis.
