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Alcoholic Ketoacidosis Pathophysiology

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Case 714 * Alcoholic Ketoacidosis * Dr. Mohammad Akram Babury, MD . Send us your feedback/suggestions. Naser Oria https://www.facebook.com/doctorsforaf... / . Visit us at / :www.doctorsforafghanistan.com Kabul # health # Acidosis # Diabetic #

Alcoholic Ketoacidosis: A Case Report And Review Of The Literature

Alcoholic ketoacidosis (AKA) is a condition that presents with a significant metabolic acidosis in patients with a history of alcohol excess. The diagnosis is often delayed or missed, and this can have potentially fatal consequences. There are a variety of non-specific clinical manifestations that contribute to these diagnostic difficulties. In particular, cases of AKA can be misdiagnosed as diabetic ketoacidosis (DKA). Subsequent mismanagement can lead to increasing morbidity and mortality for patients. AKA typically presents with a severe metabolic acidosis with a raised anion gap and electrolyte abnormalities, which are treatable if recognized early and appropriate management instituted. Given the increasing epidemic of alcohol-related healthcare admissions, this is an important condition to recognize and we aim to offer guidance on how to approach similar cases for the practising clinician. We present a 64-year-old female who presented with generalized abdominal pain, nausea, vomiting and shortness of breath. Arterial blood gas analysis showed significant acidaemia with a pH of 7.10, bicarbonate of 2.9 mmol/l and lactate of 11.7 mmol/l. Serum ketones were raised at 5.5 mmol/l. Continue reading >>

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  1. cdonoian23

    breath smells like nail polish

    So I was diagnosed with pre diabetes 1 month ago based on the oral glucose tolerance test (fasting 82, 2 hour post prandial was 193 which is pre diabetic). My A1C was 5.6 at the time, and last week it was 4.7. I have been eating approximately 12-1500 calories a day, with about 30-60 grams of carbs.
    The past few nights my husband noticed my breath smells like nail polish remover and I had been laughing about it but just decided to look it up. I'm reading this can be a sign of Diabetic Ketoacidosis. I'm not sure what to do since it's a Friday night - some websites say this could be an emergency but I don't want to freak out if it's not...Any advice??

  2. Bounty

    You can buy a blood glucose testing kit and a urine ketone test kit at any Walmart or pharmacy that's open right now.
    Incidentally...the active ingredient in nail polish remover is acetone. Which, being an automotive painter, smells nowhere near the "fruity-scented breath" of someone in ketoacidosis.

  3. Roxanne0312

    Quote:

    Originally Posted by cdonoian23
    So I was diagnosed with pre diabetes 1 month ago based on the oral glucose tolerance test (fasting 82, 2 hour post prandial was 193 which is pre diabetic). My A1C was 5.6 at the time, and last week it was 4.7. I have been eating approximately 12-1500 calories a day, with about 30-60 grams of carbs.
    The past few nights my husband noticed my breath smells like nail polish remover and I had been laughing about it but just decided to look it up. I'm reading this can be a sign of Diabetic Ketoacidosis. I'm not sure what to do since it's a Friday night - some websites say this could be an emergency but I don't want to freak out if it's not...Any advice?? Sounds like you are in dietary ketosis which is good. Means your body is burning fat instead of glucose.

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

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 pregna Continue reading >>

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Popular Questions

  1. Mrs.Christie

    Anyone know if Walgreens usually carries pH testing strips? If so, here would I look in the store? The sales associates at my local Walgreens are pretty much useless.

  2. blessednewmomma

    They may not carry them regularly, but if you ask the pharmacy they might be able to order them for you. I use to work at a retail pharmacy and sometimes that stuff was available through their wholesalers.

  3. alicia11780

    DH is a pharmacist for Walgreen's and said that they do not carry PH testing strips. He said that the only place he could think of is a lab supply company but not any retailers.

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What is KETOACIDOSIS? What does KETOACIDOSIS mean? KETOACIDOSIS meaning - KETOACIDOSIS definition - KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... 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 ß-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. 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. Ketosis may also smell, 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. Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively. In diabetic ketoacidosis, a high concentration of ketone bodies is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption, thereby inhibiting the production of oxaloacetate (a crucial molecule for processing Acetyl-CoA, the product of beta-oxidation of fatty acids, in the Krebs cycle) through reduced levels of pyruvate (a byproduct of glycolysis), and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis. In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

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, wh Continue reading >>

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Popular Questions

  1. wallflowerwendy

    Hey so every time I go into Ketosis, I get UTI-like symptoms until I start eating carbs again. When I first started doing keto diets I actually thought I had a UTI so I went to the doctor and tested negative which confused me. It kept happening every time and I JUST now put 2 and 2 together. Does anyone else have the same problem? If so, does anyone have any tips on how to stop it so I can keep going with this?
    For reference, when I do keto I go super low cal and basically only consume the necessary protein for someone my size--almost negligible fat/carbs. I can see the fat on my body getting less and less every day so I really want to be able to keep this up for longer.

  2. Anniel

    What UTI symptoms do you get? When you first go into ketosis you will lose a lot of water weight and will pee a lot and may go through what is called keto flu. This is temporary and goes away within a couple of days as long as you stay in ketosis.

  3. wallflowerwendy

    Anniel, on 15 Mar 2017 - 11:10 AM, said:

    What UTI symptoms do you get? When you first go into ketosis you will lose a lot of water weight and will pee a lot and may go through what is called keto flu. This is temporary and goes away within a couple of days as long as you stay in ketosis.
    I'be already been through keto flu. It burns to pee and I continue to pee an excessive amount every single time I do keto. This has happened 6 times so far this last year (kept track of painful cloudy peeing, never cross referenced it with my food consumption until now). Some people online have these symptoms after a couple week of keto, but I get it immediately?

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