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Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Workup When a chronic alcoholic presents with signs of AKA, the clinician should carefully evaluate the patient, obtain a history, perform a physical exam, and order the appropriate laboratory tests. Laboratory tests and results A comprehensive metabolic profile will allow the medical team to determine the overall clinical picture of the patient. This includes measurement of serum electrolytes, glucose, blood urea nitrogen (BUN), creatinine, lipase, amylase, and plasma osmolality. Also, urinalysis is helpful to detect ketones. Another useful tool is the blood alcohol level [8]. Finally, critically ill patients with positive ketones must have an analysis of their arterial blood gas (ABG) and serum lactate levels. With regards to expected findings, all patients demonstrate ketonuria and a majority display ketonemia. Also common are electrolyte imbalances such as hypokalemia, hyponatremia, hypophosphatemia, and hypomagnesemia. Additionally, the serum glucose may range from low to modest elevation while another abnormality is an increased osmolar gap (secondary to increased acetone and possibly ethanol). Most importantly, AKA is typically characterized by a high anion gap metabolic acidosis, which may be complicated by metabolic alkalosis secondary to concurrent vomiting. In cases where the pH is normal, the increased anion gap is an indicator of ketoacidosis. If there is a normal gap, this is the result of the excretion of ketoacid ions. Additionally, lactic acidosis is observed in more than 50% of cases due to hypoperfusion [9]. Differential diagnoses Differentials include diabetic ketoacidosis (DKA),however, the absence of hyperglycemia excludes this. Pancreatitis may also present similar to AKA and should be ruled out. If alcohol intoxication is not conclusive, serum me Continue reading >>

Alcoholic Ketoacidosis: Causes, Symptoms, Treatment, Prognosis

Alcoholic Ketoacidosis: Causes, Symptoms, Treatment, Prognosis

Ketoacidosis is a medical condition in which the food that is ingested by an individual is either metabolized or converted into acid. Alcoholic Ketoacidosis is a condition in which there is development of Ketoacidosis as a result of excessive alcohol intake for a long period of time and less ingestion of food resulting in malnutrition. Drinking excessive alcohol causes the individual to be able to eat less food. Additionally, if excess alcohol is ingested then it may lead to vomiting which further worsens the nutritional status of the individual which results in formation of excess acids resulting in Alcoholic Ketoacidosis. The symptoms caused by Alcoholic Ketoacidosis include abdominal pain, excessive fatigue, persistent vomiting, and the individual getting dehydrated due to frequent vomiting episodes and less fluid intake. If an individual has a history of alcohol abuse and experiences the above mentioned symptoms then it is advised that the individual goes to the nearest emergency room to get evaluated and if diagnosed treated for Alcoholic Ketoacidosis. As stated above, the root cause of Alcoholic Ketoacidosis is drinking excessive amounts of alcohol for a prolonged period of time. When an individual indulges in binge drinking he or she is not able to take in enough food that is required by the body to function. This eventually results in malnourishment. Additionally, vomiting caused by excessive drinking also results in loss of vital nutrients and electrolytes from the body such that the body is not able to function normally. This results in the insulin that is being produced by the body becoming less and less. All of these ultimately results in the development of Alcoholic Ketoacidosis. An individual may develop symptoms within a day after binge drinking, dependin Continue reading >>

Alcoholic Ketoacidosis And Isopropyl Alcohol Intoxication

Alcoholic Ketoacidosis And Isopropyl Alcohol Intoxication

To the Editor.— The editorial entitled "Cyanide Poisoning—A Challenge" (Archives 137:993-994, 1977) contained a statement that "cyanide intoxication and diabetes mellitus (are) the only two major clinical situations with very high levels of serum acetone and acetone bodies." If indeed cyanide intoxication is a major clinical situation, then I would like to add two additional situations, ie, alcoholic ketoacidosis1 and isopropyl rubbing alcohol intoxication.2The syndrome of alcoholic ketoacidosis occurs in nondiabetic alcoholics, typically after a period of prolonged vomiting and decreased food intake. The fact that a mild ketosis may arise from starvation or prolonged vomiting is well known; the mechanism for the severe ketosis reported in nondiabetic alcoholics remains speculative. The syndrome is probably underdiagnosed because there tends to be an unusually high ratio of β-hydroxybutyrate to acetoacetate; only the latter is measured by the nitroprusside test (Acetest). Therefore, a metabolic acidosis with an apparently unexplained Continue reading >>

Does Alcohol Influence The Smell Of Perspiration? If So, How?

Does Alcohol Influence The Smell Of Perspiration? If So, How?

Yes alcohol influences the smell of perspiration. It does it in at least three ways. First you can smell the alcohol coming out in the sweat. Secondly you can smell the chemicals that are from the body metabolising the alcohol. Third is most people let their personal hygiene slip when they are drinking a lot. Some people metabolize alcohol differently than most people do and develop a very distinctive odour when they drink. If the drinking is severe and prolonged there could be damage to the liver and there will be a scent released from the skin related to the toxins from the liver. Alcoholic ketoacidosis is another condition sometimes seen in heavy drinkers where the body is failing to metabolize sugars and is metabolizing fats instead. You can smell the ketones that are produced. Continue reading >>

Ketoacidosis

Ketoacidosis

Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and β-hydroxybutyrate. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal.[1] Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis. Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover.[2] Ketosis may also give off an odor, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Cause[edit] Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively.[3] In diabetic ketoacidosis, a high concentration of ketone bodies is usually accomp Continue reading >>

Alcoholic Ketoacidosis—a Review

Alcoholic Ketoacidosis—a Review

Abstract Alcoholic ketoacidosis is a frequently encountered metabolic disturbance that follows a prolonged intake of ethanol. Following a brief duration of abstinence, patients typically present with vomiting, abdominal pain, and shortness of breath. Examination reveals Kussmaul breathing, variable volume loss, and coincident manifestations of chronic alcohol usage. Characteristic laboratory findings include anion-gap metabolic ketoacidosis, normal serum glucose, and zero ethanol levels. Phosphate measurements may be depressed, particularly after institution of therapy. Intravascular volume restitution, delivery of dextrose, attention to electrolytes, and discovery of alcohol-related illnesses are the mainstays of therapy. Continue reading >>

7alcoholic Ketoacidosis: Clinical And Laboratory Presentation, Pathophysiology And Treatment

7alcoholic Ketoacidosis: Clinical And Laboratory Presentation, Pathophysiology And Treatment

Alcoholic ketoacidosis is a common condition which occurs predominantlyin chronic alcoholics. The usual picture is an interval of increased ethanol intake followed by one or more days of abdominal pain, vomiting, dehydration and a marked decrease in caloric intake. Acidosis is frequently as severe as in diabetic ketoacidosis, but the serum Acetest measurement of ketones may be negative or only slightly positive because of the predominance of β-hydroxybutyrate compared with acetoacetate. Treatment with intravenous glucose and saline are the essentials of management. Insulin, bicarbonate and phosphate are usually not needed. The major cause of morbidity and mortality is not the acidosis but rather failure to adequately treat concurrent medical or surgical conditions. Continue reading >>

Definition

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 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 Exams and Tests Arterial blood gases (measure the acid/base balance and oxygen level in blood) Blood alcohol level Blood chemistries, and liver function tests, such as CHEM-20 CBC (complete blood count, measures red and whilte blood cells, and platelets, which help blood to clot) Prothrombin time (PT, a different measure of blood clotting, often abnormal from liver disease) 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). Additional medications may be given to prevent alcohol withdrawal. Outlook (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. Possible Complications This can be a life-threatening disorder. Complications can include: Coma and Continue reading >>

Diabetic, Alcoholic And Starvation Ketoacidosis

Diabetic, Alcoholic And Starvation Ketoacidosis

Copious amounts of ketones which are generated in insulin-deficient or insulin-unresponsive patients will give rise to a high anion gap metabolic acidosis. Ketones are anions, and they form the high anion gap. Management of DKA and HONK is discussed elsewhere. Meet the ketones Chemically speaking, a ketone is anything with a carbonyl group between a bunch of other carbon atoms. The above are your three typical ketoacidosis-associated ketone bodies. The biochemistry nerds among us will hasten to add that the beta-hydroxybutyrate is in fact not a ketone but a carboxylic acid, but - because it is associated with ketoacidosis, we will continue to refer to it as a ketone for the remainder of this chapter, in the spirit of convention. In the same spirit, we can suspend our objections to acetone being included in a discussion of ketoacidosis, which (though a true ketone) is in fact not acidic or basic, as it does not ionise at physiological pH (its pKa is 20 or so). So really, the only serious ketone acid is acetoacetate, which has a pKa of 3.77. However, beta-hydroxybutyrate is the prevalent ketone in ketoacidosis; the normal ratio of beta-hydroxybutyrate and acetoacetate is 3:1, and it can rise to 10:1 in diabetic ketoacidosis. Acetone is the least abundant. The metabolic origin of ketones The generation of ketones is a normal response to fasting, which follows the depletion of hepatic glycogen stores. Let us discuss normal physiology for a change. You, a healthy adult without serious alcohol problems, are fasting from midnight for a routine elective hernia repair. You will go to be after dinner with a few nice lumps of undigested food in your intestine, as well as about 75g of hepatic glycogen. As you sleep, you gradually digest the food and dip into the glycogen store. At Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis Damian Baalmann, 2nd year EM resident A 45-year-old male presents to your emergency department with abdominal pain. He is conscious, lucid and as the nurses are hooking up the monitors, he explains to you that he began experiencing abdominal pain, nausea, vomiting about 2 days ago. Exam reveals a poorly groomed male with dry mucous membranes, diffusely tender abdomen with voluntary guarding. He is tachycardic, tachypneic but normotensive. A quick review of the chart reveals a prolonged history of alcohol abuse and after some questioning, the patient admits to a recent binge. Pertinent labs reveal slightly elevated anion-gap metabolic acidosis, normal glucose, ethanol level of 0, normal lipase and no ketones in the urine. What are your next steps in management? Alcoholic Ketoacidosis (AKA): What is it? Ketones are a form of energy made by the liver by free fatty acids released by adipose tissues. Normally, ketones are in small quantity (<0.1 mmol/L), but sometimes the body is forced to increase its production of these ketones. Ketones are strong acids and when they accumulate in large numbers, their presence leads to an acidosis. In alcoholics, a combination or reduced nutrient intake, hepatic oxidation of ethanol, and dehydration can lead to ketoacidosis. Alcoholics tend to rely on ethanol for their nutrient intake and when the liver metabolizes ethanol it generates NADH. This NADH further promotes ketone formation in the liver. Furthermore, ethanol promotes diuresis which leads to dehydration and subsequently impairs ketone excretion in the urine. Alcoholic Ketoacidosis: How do I recognize it? Typical history involves a chronic alcohol abuser who went on a recent binge that was terminated by severe nausea, vomiting, and abdominal pain. These folk Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

What is alcoholic ketoacidosis? Cells need glucose (sugar) and insulin to function properly. 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. To get the energy you need, your body will start to burn fat. When your body burns fat for energy, byproducts known as ketone bodies are produced. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream. This buildup of ketones can produce a life-threatening condition known as ketoacidosis. Ketoacidosis, or metabolic acidosis, occurs when you ingest something that is metabolized or turned into an acid. This condition has a number of causes, including: shock kidney disease abnormal metabolism In addition to general ketoacidosis, there are several specific types. These types include: alcoholic ketoacidosis, which is caused by excessive consumption of alcohol diabetic ketoacidosis (DKA), which mostly develops in people with type 1 diabetes starvation ketoacidosis, which occurs most often in women who are pregnant, in their third trimester, and experiencing excessive vomiting Each of these situations increases the amount of acid in the system. They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones. Alcoholic ketoacidosis can develop when you drink excessive amounts of alcohol for a long period of time. Excessive alcohol consumption often causes malnourishment (not enough nutrients for the body to function well). People who drink large quantities of alcohol may not eat regularly. They may also vomit as a result of drinking too Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

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, a condition in which there is too much acid in body fluids. Causes Alcoholic ketoacidosis is caused by very heavy alcohol use. It most often occurs in a malnourished person who drinks large amounts of alcohol every day. Symptoms Symptoms of alcoholic ketoacidosis include: Nausea and vomiting Abdominal pain Changed level of alertness, which may lead to coma Loss of appetite Exams and Tests Tests may include: Blood alcohol level Blood chemistries and liver function tests CBC (complete blood count), measures red and white blood cells, and platelets, which help blood to clot) Prothrombin time (PT), a different measure of blood clotting, often abnormal from liver disease) Toxicology (poison) screening Treatment Treatment may involve fluids (salt and sugar solution) given through a vein. You may need to have frequent blood tests. You may get vitamin supplements to treat nutritional deficiencies caused by excess alcohol use. People with this condition are usually admitted to the hospital, often to the intensive care unit (ICU). Additional medicines may be given to prevent alcohol withdrawal. Outlook (Prognosis) Prompt medical attention improves the overall outlook. How severe the alcohol use is, and the presence of liver disease or other problems, may also affect the outlook. Possible Complications This can be a life-threatening condition. Complications may include: When to Contact a Medical Professional If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help. For more information on testing, diagnostic, surgical and treatment services available at H Continue reading >>

Characteristics Of Severe Alcoholic Ketoacidosis With A Reversible Visual Disturbance

Characteristics Of Severe Alcoholic Ketoacidosis With A Reversible Visual Disturbance

No. Age Sex Alcohol intake Alcoho history Conscious Level Pupil diameter Light reflex Systolic BP unit year g/day year mm mmHg 1 66 Male ? 24 Alert 4 none 82 2 53 Male 100 20 Semicoma 6 none 90 3 63 Male ? ? Alert ? ? 90 4 44 Male 200 over 5 Alert 7 none 80 5 59 Male 170 40 Alert 4 sluggish 73 6 48 Male 180 over 8 Semicoma 7 none 87 7 61 Male ? ? Disoriented 5 ? 65 8 49 Male ? ? Alert ? ? 73 9 48 Female over 110 ? Disoriented ? sluggish 134 10 68 Male ? ? Disoriented 3.5 none 150 11 56 Male ? ? Disoriented 5 none 79 12 49 Female ? ? Alert 3 none 130 13 43 Male 180 over 10 Disoriented ? ? 80 14 57 Female ? ? Alert Dilated sluggish 120 No. pH PCO2 PO2 HCO3 Base excess Lactate Glucose Alcohol BHBA AAA Thiamine deficiency Require of_IC Arrest DH Outcome unit mmHg mmHg mmHg mg/dl mg/dl mmol/l mmol/l mg/dl μmol/l μmol/l 1 6.855 13.9 190.5 2.5 -31.4 ? 69 45.8 140 14 no yes no survival 2 6.497 51 ? 3.8 -29 ? ? 8 1190 332 no yes yes survival 3 6.612 14 ? 1.5 -28 ? ? not exam 6360 261 no yes yes survival 4 6.707 13.6 272.8 1.6 -30 ? 91 0 245 11 no yes yes death 5 6.748 13 134 1.7 -33 270 70 not exam 2160 220 no yes no survival 6 6.748 20.3 151 2.6 -33.9 297 85 27.4 ? ? not exam yes no survival 7 6.623 35.0 231 3.5 -34 ? ? ? 2960 460 no yes yes death 8 6.78 15.5 118 2.3 -31 ? ? ? ? ? no no no survival 9 6.64 8.3 159 ? -37.5 109 153 not exam 823 272 no yes yes survival 10 6.79 11.8 137.2 1.8 -33 ? 38 not exam 4825 210 not exam yes no survival 11 6.55 44.4 198 3.7 -29.4 ? 20 not exam not exam not exam not exam yes no survival 12 6.79 8 196 ? ? 90 ? 68 ? 8.82 no ? no survival Arrest No-Arrest p-value n=6 n=8 Age 52.0 + 3.4 56.5 + 2.7 n.s. Sex (Male/Female) 5/1 6/2 n.s. Consciousness (number of alert) 2 5 n.s. Systolic blood pressure (mmHg) 89.8 + 9.5 99.2 + 10.5 n.s. pH 6.637 + 0.0 Continue reading >>

Alcoholic Ketoacidosis

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, a condition in which there is too much acid in body fluids. Alternative Names Ketoacidosis - alcoholic; Alcohol use - alcoholic ketoacidosis Alcoholic ketoacidosis is caused by very heavy alcohol use. It most often occurs in a malnourished person who drinks large amounts of alcohol every day. Symptoms Symptoms of alcoholic ketoacidosis include: Nausea and vomiting Abdominal pain Agitation, confusion Changed level of alertness, which may lead to coma Fatigue, slow sluggish movements Deep, labored, rapid breathing Loss of appetite Symptoms of dehydration, such as dizziness, lightheadedness, and thirst Exams and Tests Tests may include: Arterial blood gases (measures the acid/base balance and oxygen level in blood) Blood alcohol level Blood chemistries and liver function tests CBC (complete blood count), measures red and white blood cells, and platelets, which help blood to clot) Prothrombin time (PT), a different measure of blood clotting, often abnormal from liver disease) Toxicology (poison) screening Urine ketones Treatment Treatment may involve fluids (salt and sugar solution) given through a vein. You may need to have frequent blood tests. You may get vitamin supplements to treat nutritional deficiencies caused by excess alcohol use. People with this condition are usually admitted to the hospital, often to the intensive care unit (ICU). Additional medicines may be given to prevent alcohol withdrawal. Outlook (Prognosis) Prompt medical attention improves the overall outlook. How severe the alcohol use is, and the presence of liver disease or other problems, may als Continue reading >>

Severe Metabolic Acidosis In The Alcoholic: Differential Diagnosis And Management

Severe Metabolic Acidosis In The Alcoholic: Differential Diagnosis And Management

1 A chronic alcoholic with severe metabolic acidosis presents a difficult diagnostic problem. The most common cause is alcoholic ketoacidosis, a syndrome with a typical history but often misleading laboratory findings. This paper will focus on this important and probably underdiagnosed syndrome. 2 The disorder occurs in alcoholics who have had a heavy drinking-bout culminating in severe vomiting, with resulting dehydration, starvation, and then a β- hydroxybutyrate dominated ketoacidosis. 3 Awareness of this syndrome, thorough history-taking, physical examination and routine laboratory analyses will usually lead to a correct diagnosis. 4 The treatment is simply replacement of fluid, glucose, electrolytes and thiamine. Insulin or alkali should be avoided. 5 The most important differential diagnoses are diabetic ketoacidosis, lactic acidosis and salicylate, methanol or ethylene glycol poisoning, conditions which require quite different treatment. 6 The diagnostic management of unclear cases should always include toxicological tests, urine microscopy for calcium oxalate crystals and calculation of the serum anion and osmolal gaps. 7 It is suggested here, however, that the value of the osmolal gap should be considered against a higher reference limit than has previously been recom mended. An osmolal gap above 25 mosm/kg, in a patient with an increased anion gap acidosis, is a strong indicator of methanol or ethylene glycol intoxication. Continue reading >>

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