Ketones are a type of acid that form when the body breaks down fat for energy. Vomiting caused by alcohol consumption can lead to dehydration, which may, in turn, cause low blood pressure and stress response from the body that causes further ketone production. Ketoacidosis occurs due to excess ketones in the body, which are produced when the body does not have enough protein or carbohydrate stores. The body normally breaks down carbohydrates, proteins, and fats into glucose­–the body’s primary energy source. When the body is depleted of carbohydrates and protein stores, fatty acids are released from fatty tissue.

  • During this period of starvation, vomiting continues and abdominal pain develops, leading the patient to seek medical attention.
  • But it can happen after an episode of binge drinking in people who do not chronically abuse alcohol.
  • Learn about this harmful condition and what you can do to prevent it.
  • Medically supervised detoxification can reduce the risk of severe withdrawal symptoms (which can contribute to AKA development) and the risk of relapse.
  • Pancreatitis Overview of Pancreatitis Pancreatitis is classified as either acute or chronic.
  • Fat cells begin breaking down, producing compounds called ketones.

The remainder of the patient’s laboratory evaluation – including liver enzymes, amylase, and lipase – were within normal limits, and methanol, ethylene glycol, salicylate, and digoxin levels were negative. Of note in the table above, the patient’s INR was greater than 11, above the upper limit of the assay, and this was confirmed by repeating the test. AKA is a diagnosis of exclusion, and many other life-threatening alternative or concomitant diagnoses present similarly, and must be ruled out. Failure to make the diagnosis can result in severe metabolic abnormalities, acidosis, and shock.

How is alcoholic ketoacidosis treated?

The dextrose will also increase glycogen stores and diminish counterregulatory hormone levels. It is essential to administer thiamine before any glucose administration to avoid Wernicke’s encephalopathy preci[itation. If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized. Other electrolyte abnormalities concomitantly present with alcohol abuse and poor oral intake include hypomagnesemia and hypophosphatemia. Magnesium and phosphate levels should be measured and repleted if the serum levels are found low.

Similar symptoms in a person with alcoholism may result from acute pancreatitis Acute Pancreatitis Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening but usually subsides. Gallstones and alcohol abuse are the main causes of acute pancreatitis. Symptoms of diabetic ketoacidosis include nausea, vomiting, abdominal pain, and a characteristic… The doctor must exclude these other causes before diagnosing alcoholic ketoacidosis. People who go on a major alcohol binge often vomit repeatedly and stop eating.

Who Is at Risk for Alcoholic Ketoacidosis?

You can’t be sure what the underlying cause is, and you may require immediate medical attention. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website,  INTENSIVE.

This can quickly become a problem because ketones are highly acidic, and an oversupply makes the body too acidic. And these high levels of acidity can lead to several other serious health issues. These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis. People who drink large quantities of alcohol may not eat regularly. Not eating enough or vomiting can lead to periods of starvation.

Diagnosis of Alcoholic Ketoacidosis

Assess the patient’s airway and manage as clinically indicated. Although the underlying pathophysiology is complex, a proper comprehension greatly aids in the diagnosis and management of this condition.

  • When glycogen stores are depleted in a patient stressed by concurrent illness or volume depletion, insulin secretion is also suppressed.
  • Excessive drinking damages the pancreas, impacting insulin production.
  • To learn how you can start a journey toward recovery, contact us at Gateway Foundation today.

Patients often need hydration, potassium repletion and dextrose injections to stimulate insulin production. Every patient is different, and careful monitoring is essential during the treatment process. Ketone production can be further stimulated in malnourished, vomiting patients or in those who are hypophosphatemic.6 Both conditions are seen commonly in alcoholic patients with alcoholic ketoacidosis.


Going on a drinking binge when your body is in a malnourished state may cause abdominal pain, nausea, or vomiting. Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder. Ethanol metabolism results in NAD depletion manifesting as a higher ratio of the reduced form of nicotinamide adenine dinucleotide (NADH) to NAD. When glycogen stores are depleted in a patient stressed by concurrent illness or volume depletion, insulin secretion is also suppressed. Under these same conditions, glucagon, catecholamine, and growth hormone secretion are all stimulated.

Thiamine supplementation should also be given upon initiation of dextrose. Note information about the patient’s social situation and the presence of intoxicating agents besides alcohol. If the patient’s alcoholic ketoacidosis symptoms mental status is diminished, consider administration of naloxone and thiamine. If you or someone you love displays these symptoms, you should consult a medical professional as quickly as possible.

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Glucose comes from the food you eat, and insulin is produced by the pancreas. When you drink alcohol, your pancreas may stop producing insulin for a short time. Without insulin, your cells won’t be able to use the glucose you consume for energy. This drop in blood sugar causes your body to decrease the amount of insulin it produces. Your cells need insulin to use the glucose in your blood for energy. If they can’t use glucose because there’s not enough insulin, your body switches to another method to get energy — breaking down fat cells.

These are examples of when calculating alcohol consumption isn’t always straightforward. They are important, however, when making distinctions between normal and excessive levels of alcohol consumption. Someone may think they are consuming 3-4 drinks a day when, in actuality, they are consuming closer to 6 or more. Having six or more drinks would be considered a binge drinking episode. The liver’s inability to synthesize and release glucose can also lead to dangerously high levels of lactate. Excess levels of lactate can result in lactic acidosis, which further complicates AKA.3,5 Excessive use of alcohol can also lead to other medical issues such as alcoholic cirrhosis.

Treatment Options for Alcoholic Ketoacidosis

Alcohol withdrawal, in combination with nausea and vomiting, makes most patients agitated. However, if an AKA patient is lethargic or comatose, an alternative cause should be sought. The typical history is an episode of heavy drinking followed … Limiting the amount of alcohol you drink will help prevent this condition. Medically supervised detox is part of a general approach to addiction treatment called medically-assisted treatment (MAT).