Alcoholic Ketoacidosis: Causes, Symptoms, and Treatment

What Is Alcoholic Ketoacidosis?

Alcoholic ketoacidosis is a condition that can be an outcome of heavy drinking. It usually happens when one has been vomiting and has not been eating properly. In alcoholic ketoacidosis, ketones, which are a kind of acid, build up in the blood.

Ketoacidosis, also known as metabolic acidosis, is when something is ingested that turns into acid. There are different types of ketoacidosis:

• Diabetes ketoacidosis, which is a condition observed in type 1 diabetes.
• Starvation ketoacidosis, which is generally seen during the third trimester of pregnancy.
• Alcoholic ketoacidosis, which is usually after heavy drinking sessions.

Alcoholic ketoacidosis needs to be addressed immediately. If not, it can be life-threatening.

Alcoholic ketoacidosis can sometimes be confused as alcoholic ketosis because of the similarity of names. However, heavy drinking is one of the reasons for ketosis, which happens when the body does not have carbohydrates to burn for energy, therefore, it burns fat. It is a condition commonly associated with diabetes.

What Are The Causes Of Alcoholic Ketoacidosis?

Alcoholic ketoacidosis usually develops after heavy drinking episodes. The cells in the body need glucose and insulin to function optimally. Pancreas are responsible for producing insulin. When one consumes alcohol, pancreas can stop producing insulin for a certain period of time. In the absence of insulin, cells cannot use glucose for energy. So, instead, they start burning fat.

When cells start burning fat, ketones are produced. Ketones are acids. When they build up in the body, they give rise to ketoacidosis.

Heavy drinking episodes often lead to starvation or not eating properly. It can also lead to vomiting, which further depletes insulin production in the body. If a person then consumes alcohol, alcohol ketoacidosis can develop.

What Are The Symptoms Of Alcoholic Ketoacidosis?

Alcoholic ketoacidosis symptoms depend on the amount of alcohol consumed and the ketones in the body. The general symptoms are as follows:

• Confusion
• Agitation
• Reduction in appetite
• Abdominal pain
• Vomiting
• Dehydration
• Vertigo
• Dizziness
• Slowed movement
• Rapid breathing

If anybody is suffering from these conditions, it is crucial to contact the nearby healthcare providers immediately. If not given immediate attention, alcoholic ketoacidosis can become a life-threatening condition.

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Causes and Risk Factors of Alcoholic Ketoacidosis

Alcoholic ketoacidosis is caused by the build-up of ketones in the bloodstream. It usually develops after heavy or binge drinking episodes, which can stop the pancreas from producing insulin for some period of time. As cells are not able to burn glucose without insulin, they burn fat, leading to the build-up of ketones in the bloodstream.

Certain risk factors of alcoholic ketoacidosis are:

• Chronic and heavy drinking
• The presence of an alcohol use disorder
• Malnourishment due to alcohol
• Other underlying conditions associated with heavy alcohol use, like pancreatitis, liver and kidney diseases, and ulcers.

Diagnosing Alcoholic Ketoacidosis

If symptoms of alcoholic ketoacidosis are present, to confirm whether or not it is the said condition, the doctor can perform a few physical examinations:

• Blood alcohol test
• Blood glucose test
• Urine test (to test the level of ketones)
• Amylase and lipase tests (to test the functioning of pancreas)
• Arterial blood gas test (to check blood oxygen levels as well as acid/base balance)
• Anion gap calculation (to test potassium and sodium levels)
• Blood chemistry panel (to check metabolism rates)
• Blood urea nitrogen test (to test kidney functioning)
• Creatinine tests (to test kidney functioning)
• Serum lactate test (to check lactate levels in the blood)

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Treatment Options for Alcoholic Ketoacidosis

Alcoholic ketoacidosis is treated as an emergency condition in the emergency room. The vitals are consistently monitored and fluids are administered intravenously.

To treat malnourishment associated with alcohol, vitamins and nutrients are provided, which include magnesium, phosphorus, potassium, and thiamine.

Depending on how severe the alcohol ketoacidosis is, the person may be monitored closely in the ICU. In case of complications, the length of the treatment can be extended.

While these are the treatment options available for alcoholic ketoacidosis, the broader problem of uncontrolled drinking or alcohol use disorder needs to be treated. This involves medically-supervised detoxification and rehabilitation, which includes psychotherapeutic interventions like motivational interviewing, cognitive behavioral therapy, contingency management, group therapy, and 12-step recovery programs.

Complications of Alcoholic Ketoacidosis

Alcoholic ketoacidosis is a life-threatening condition in itself. However, it can also involve certain complications that can extend the treatment as well as the stay in the hospital. These complications are as follows:

• Pneumonia
• Pancreatitis (inflamed pancreas)
• Gastrointestinal bleeding
• Encephalopathy (a brain disorder that can lead to confusion, memory problems, personality changes, or even coma)
• Seizures
• Coma

Along with the above, even the symptoms of alcohol withdrawal need to be managed. In case of dependence on alcohol, the body will not function normally in the absence of alcohol and one can experience intense and unpleasant alcohol withdrawal symptoms like agitation, restlessness, wakefulness, headache, sweating, tremors, hyperthermia, psychosis, delirium, and so on.

Preventing Alcoholic Ketoacidosis

As alcoholic ketoacidosis is related to heavy drinking, the only way to prevent alcoholic ketoacidosis is to limit alcohol consumption. Of course, in cases of alcohol dependence and alcohol use disorder, this is very difficult. In fact, abruptly quitting alcohol can lead to severe (and even life-threatening) withdrawal symptoms. Therefore, seeking medical advice and professional help for alcohol dependence and alcohol use disorder is important. These conditions must be managed carefully with medically-supervised detoxification, psychotherapeutic interventions, and social support for lasting recovery and sobriety.

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Frequently Asked Questions

How do you know if you have alcoholic ketoacidosis?

Abdominal pain, slowed movement, dizziness, vertigo, vomiting, decreased appetite, rapid breathing are all symptoms of alcoholic ketoacidosis which can result after heavy drinking.

Is alcoholic ketoacidosis an emergency?

Yes, alcoholic ketoacidosis is an emergency. If not given immediate medical attention, it can turn life-threatening.

How to differentiate between alcoholic and diabetic ketoacidosis?

Symptoms of alcoholic ketoacidosis are confusion, vomiting, abdominal pain, while symptoms of diabetic ketoacidosis are thirst, frequent urination, and abdominal pain. Tests can also help differentiate between them, as blood alcohol levels can help determine alcoholic ketoacidosis while hemoglobin A1C helps determine diabetic ketoacidosis.