Overview
Alcoholic ketoacidosis (AKA) is a euglycaemic ketoacidosis occurring in patients suffering from chronic alcohol excess abuse. It usually emerges a few days following a period of not eating.
Pathophysiology
Chronic excessive alcohol consumption can lead to impaired gluconeogenesis and reduce hepatic glycogen stores. This leads to the metabolism of fatty acids and the generation of ketone acids leading to metabolic acidosis.
Presentation
AKA should be considered in patients presenting with features similar to diabetic ketoacidosis, but are euglycaemic. Patients may have:
- Abdominal pain
- Nausea and vomiting
- Tachypnoea
- Hypotension
Investigations
- Blood glucose concentration:
- Normal
- Serum ketones:
- Elevated
- Arterial/venous blood gas:
- Elevated anion gap metabolic acidosis
Management
- 1st-line: IV saline and thiamine to prevent the development of Wernicke encephalopathy.
