Alcoholic Ketoacidosis
OVERVIEW
- rare
- small proportion of chronic ethanol abusers
- relatively benign if patients given IV dextrose and fluids
- unclear aetiology
? starvation, dehydration, excess acetate production, altered redox state, hormonal imbalances, genetic predisposition
HISTORY
- alcohol binge -> when blood alcohol level declining + not eating
- anorexia
- nausea
- epigastric pain
- vomiting
EXAMINATION
- clear sensorium
- acetone odour
- tachypnoea or Kussmaul respiration (if marked acidaemia)
- tachycardia
- volume depletion
INVESTIGATIONS
- ABG: metabolic acidosis, ketonaemia, ketonuria (may have metabolic alkalosis if has severe vomiting)
- normal, low or slightly high blood glucose
- ratio of beta-hydroxybutyerate to acetoacetate seen in alcoholic is higher than seen in DKA
MANAGEMENT
- exclude other causes for metabolic acidosis (AKA is a diagnosis of exclusion)
- give fluid + dextrose
- monitor closely for refeeding syndrome
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC