Makindo Medical Notes

Related Subjects: |Metabolic acidosis |Lactic acidosis

Alcohol reduces hepatic gluconeogenesis, leading to decreased insulin secretion, increased lipolysis, impaired fatty acid oxidation, and subsequent ketogenesis. Blood glucose is often normal or low.

About

• Alcoholic ketoacidosis is associated with malnutrition, prolonged alcohol consumption, dehydration, and episodes of starvation.

Aetiology

• Impaired gluconeogenesis due to alcohol consumption.
• Increased stress hormones such as catecholamines, glucagon, growth hormone, and steroids promote lipolysis.
• The byproduct of lipolysis, ketones, accumulates leading to ketoacidosis.

Clinical Presentation

• Signs of alcoholism and possible liver disease.
• Tachypnoea, tachycardia, hypotension.
• Symptoms of malnutrition, ketones in breath, vomiting, abdominal pain.
• Assess for signs of liver decompensation: encephalopathy, jaundice, and ascites.

Investigations

• Blood tests: U&E, calcium, phosphate, magnesium. AKI may be present. Look for low K, Mg, P, and calcium.
• FBC: Anaemia and raised WCC may be present.
• PT: Prolonged in some cases.
• LFTs: May show abnormal results, especially in chronic alcoholics.
• Ascites: Diagnostic tap may be needed to exclude spontaneous bacterial peritonitis (SBP).
• Elevated ketones, normal or low glucose.
• ABG: Metabolic acidosis with a large anion gap, elevated serum lactate.
• Urine: Test for ketones.

Management

• Rehydration: Administer 5% dextrose cautiously, titrate based on volume status.
• Vitamin supplementation: IV Pabrinex (thiamine, vitamins B and C), Chlordiazepoxide for alcohol withdrawal.
• Monitor and adjust potassium, magnesium, and phosphate levels.
• Administer 10% dextrose IV if hypoglycaemia is present.
• IV antibiotics if sepsis is suspected after appropriate cultures (urine, chest, blood, ascitic fluid) are taken.
• CT abdomen if surgical complications are suspected.
• Involve alcohol addiction support services once the patient is stable.

References

• Review Article on Alcoholic Ketoacidosis, 2006