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Alcoholic ketoacidosis

Definition:

Alcoholic ketoacidosis is the buildup of ketones in the blood. Ketones are a type of acid that form when the body breaks down fat for energy.

The condition is an acute form of metabolic acidosis .



Alternative Names:

Ketoacidosis - alcoholic



Causes, incidence, and risk factors:

Alcoholic ketoacidosis is caused by excessive alcohol use. It is most often seen in a malnourished person who drinks large amounts of alcohol every day.



Symptoms:
  • Abdominal pain
  • Agitation
  • Changed level of alertness, which may lead to coma
  • Confusion
  • Fatigue
  • Slow, sluggish, lethargic movement
  • Irregular deep, rapid breathing (Kussmaul's sign)
  • Loss of appetite
  • Nausea and vomiting
  • Symptoms of dehydration , such as dizziness, light-headedness, and thirst


Signs and tests:
  • Arterial blood gases (measure the acid/base balance and oxygen level in blood)
  • Blood alcohol level
  • Blood chemistries, such as CHEM-20
  • Toxicology (poison) screening
  • Urine ketones


Treatment:

Treatment may involve fluids (salt and sugar solution) given through a vein. You may need to have your blood taken often. You may get vitamin supplements to treat nutritional deficiencies caused by excess alcohol use.

People with this condition are admitted to the hospital, often to the intensive care unit (ICU).



Support Groups:



Expectations (prognosis):

Prompt medical attention improves the overall outlook. How severe the alcoholism is, and the presence of liver disease or other complications also affect the outlook.



Complications:

This can be a life-threatening disorder. Complications can include:



Calling your health care provider:

If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help.



Prevention:

Limiting the amount of alcohol you drink may help prevent this condition.



References:

Cho KC, Fukagawa M, Kurokawa K. Fluid and electrolyte disorders. In: McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment. 48th ed. New York, NY: McGraw-Hill; 2009:chap 21.

DuBose TD Jr. Acidosis and alkalosis. In: Fauci A , Kasper D, Longo DL, et al, eds. Harrison's Principals of Internal Medicine. 17th ed. New York, NY: McGraw Hill; 2008:chap 48.

Wiener SW, Hoffman RS. Alcoholic ketoacidosis. In: Wolfson Ab, Hendey GW, Ling LJ, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 25.




Review Date: 4/1/2011
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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