Endocrinology Made Simple : Alcoholic ketoacidosis

Alcoholic ketoacidosis:

This is seen in overuse of alcohol.

It is characterized by anion gap acidosis,increased osmolal gap,ketonemia,or ketonuria and variable blood glucose levels.

Blood glucose levels are mostly higher than 250 mg/dl in patients with diabetic ketoacidosis.

Clinical features:

Impaired mental function with ketonuria.

Mildly elevated plasma glucose levels.

Plasma glucose levels can be low,high or normal.

High plasma glucose levels can be due to impaired insulin secretion combined with increased insulin resistance.

Biochemically the patients with alcoholic ketoacidosis will have increased anion and osmolal gap.

Complications

Potential complications in Alcoholic ketoacidosis includes the following:

Alcohol withdrawal

Electrolyte imbalance

Aspiration pneumonia

Wernicke”s encephalopathy :

This can occur due to administration of glucose that can increase utilization of thiamine and thus aggravating thiamine deficiency and causing Wrnicke”s encephalopathy.

Management:

Most patients will respond to an administration of intravenous dextrose containing normal saline and thiamine.

All patients should be hospitalized for treatment.

Insulin is generally not required.

Dextrose leads to an increase in insulin secretion that leads to metabolism of ketone bodies to bicarbonate.

Thiamine is likely to be deficient in all will alcohol consumption unless proven otherwise.