Emergent Treatment of Alcoholic Ketoacidosis: Overview, Prehospital Care, Emergency Department Care

Medications such as naltrexone can reduce cravings and reduce alcohol consumption. Talk to your doctor if you or someone you know is struggling with alcohol. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world.

How Can Alcoholic Ketoacidosis Be Prevented?

Alcoholic ketoacidosis most commonly happens in people who have alcohol use disorder and chronically drink a lot of alcohol. But it can happen after an episode of binge drinking in people who do not chronically abuse alcohol. Alcoholic ketoacidosis doesn’t occur more often in any particular race or sex. Lactic alcoholic ketoacidosis acidosis is a health condition characterized by elevated lactate levels in the body. These high lactate levels may result from increased cell production, decreased clearance (mainly within the liver), or some combination. Alcoholic ketoacidosis is usually triggered by an episode of heavy drinking.

Type B Lactic Acidosis

• These agents are rarely used for the management of severe metabolic acidosis.
• People who consume a lot of alcohol during one occasion often vomit repeatedly and stop eating.
• Group meetings provide support for people trying to quit drinking.
• The prevailing myth in society is that “problem drinkers” have a moral weakness.

If you have concerns about developing lactic acidosis, speak with a healthcare provider. Early attention and treatment are key to managing this complex condition. People most at risk for metformin-induced lactic acidosis are those with underlying kidney disease and other conditions that make them vulnerable to hypoperfusion (e.g., sepsis). Septic shock is one of the most common causes of type A lactic acidosis.

Differential Diagnosis

• An elevated lactate is between 2 and 5 mmol/L, whereas a severely elevated lactate level is greater than 5 mmol/L.
• Support groups can be a valuable source of support and can be combined with medication and therapy.
• Limiting the amount of alcohol you drink will help prevent this condition.
• Other symptoms may be present depending on the underlying cause and severity of the acidosis.
• Assess the patient’s airway and manage as clinically indicated.
• Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism.
• But it can happen after an episode of binge drinking in people who do not chronically abuse alcohol.

Stigma and lack of education remain major barriers to people getting the therapeutic attention they need and deserve. Types of shock include septic (widespread infection), hypovolemic (loss of blood/fluid), and cardiogenic (heart malfunctioning) shock. In addition, blood lactate levels should be tracked (if elevated) and used as a resource when choosing therapies to optimize chances for a full recovery.

When you drink alcohol, your pancreas may stop producing insulin for a short time. Without insulin, your cells won’t be able to use the glucose you consume for energy. To get the energy you need, your body will start to burn fat. Alcohol use, addiction and alcohol-related death are rising among women. The treatment of type B lactic acidosis is geared towards the specific cause. Sorting out the type and cause of lactic acidosis is key to guiding treatment.

If the patient’s blood glucose level is significantly elevated, AKA may be indistinguishable from diabetic ketoacidosis (DKA). Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia.

• Not eating enough or vomiting can lead to periods of starvation.
• Thiamine supplementation should also be given upon initiation of dextrose.
• Vitamin supplements (e.g. thiamine, vitamins B12 and folate) can be helpful for those at high risk for developing alcohol-induced vitamin deficiencies.

Specifically look for nystagmus, confusion, ataxia, confabulation, and restriction of extraocular movements. Strongly consider providing thiamine supplementation to patients with alcohol dependence even without signs of thiamine deficiency. Prevention of AKA involves the treatment of chronic alcohol abuse. The remainder of the patient’s laboratory evaluation – including liver enzymes, amylase, and lipase – were within normal limits, and methanol, ethylene glycol, salicylate, and digoxin levels were negative. Of note in the table above, the patient’s INR was greater than 11, above the upper limit of the assay, and this was confirmed by repeating the test.

Keep in mind that temporary causes of type A lactic acidosis, namely overexercising, are usually treated at home with rest and fluids. In such cases, a person’s liver and (to a lesser degree) kidneys eventually clear the lactate from the bloodstream. Arrange follow-up to evaluate patients after the resolution of symptoms, in order to detect other complications of chronic alcohol abuse. The patient may benefit from an alcohol rehabilitation program.

History and Physical

Appropriately evaluate the patient for any life-threatening complications before a transfer is considered.