Alcohol ketoacidosis

Background

• 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)

1. Hydration

• IVF should include 5% dextrose since there is a lack of glucose

1. Thiamine (100mg IV/PO) prior to glucose to decrease risk of Wernicke encephalopathy or Korsakoff syndrome
2. Oral nutrition if able to tolerate
3. Electrolyte replacement - K, Mag and Phos
4. Monitor for signs of alcohol withdrawal
5. Consider bicarb if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy

Disposition

1. Most go home after treatment if able to tolerate POs and acidosis resolved
2. Consider admission for those with severe volume depletion and/or acidosis

Hypoglycemia is poor prognostic feature, indicating depleted glycogen stores

See Also

Anion Gap (High)

Acid-Base Disorders