|
|
| (9 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| == Background ==
| | #REDIRECT[[Alcoholic ketoacidosis]] |
| *Seen in pts with recent h/o binge drinking with little/no nutritional intake
| |
| **Starvation leads to excess glucagon and decreased insulin
| |
| **Elevated NADH:NAD+ ratio due to ETOH metabolism
| |
| **Volume depletion from emesis & poor PO intake
| |
| *Characterized by high serum ketone levels and an elevated AG
| |
| **Consider other causes of elevated AG, as well as co-ingestants
| |
| **Concomitant metabolis alkalosis can occur from dehydration (volume depletion) and emesis
| |
| | |
| == Treatment ==
| |
| Consider associated diseases (ie pancreatitis, rhabdo, hepatitis, infections)
| |
| #Hydration | |
| ##IVF should include 5% dextrose since there is a lack of glucose
| |
| ##Note: Thiamine (100mg IV/PO) prior to glucose to decrease risk of Wernicke encephalopathy or Korsakoff syndrome
| |
| #Oral nutrition if able to tolerate
| |
| #Electrolyte replacement - K, Mag and Phos
| |
| #Monitor for signs of alcohol withdrawal
| |
| #Consider bicarb if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy
| |
| | |
| == Disposition ==
| |
| #Most go home after treatment
| |
| #Consider admission for those with severe volume depletion and/or acidosis
| |
| *Hypoglycemia is poor prognostic feature
| |
