Cardiovascular disease continues to be one of the leading causes of death among all Americans and is the leading cause of death in people with type 2 diabetes (Bierman 1992). The relationship of alcohol consumption to cardiovascular disease in diabetic people has not been well evaluated. However, substantial alcoholic ketoacidosis smell information on the association of alcohol and cardiovascular disease exists from population studies that included an unknown percentage of diabetics. Those findings suggest that alcohol consumption, particularly moderate consumption, may have a protective effect against cardiovascular disease.
Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder. Diabetic eye disease (i.e., retinopathy) is another troublesome tissue complication of diabetes and one of the leading causes of blindness in the United States today. Good blood sugar and blood pressure control as well as regular eye examinations are essential for the prevention of retinopathy.
The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an alcohol use disorder. The test is free, confidential, and no personal information is needed to receive the result. If you are diagnosed with alcoholic ketoacidosis, your recovery will depend on a number of factors. Seeking help as soon as symptoms arise reduces your chances of serious complications. Treatment for alcohol addiction is also necessary to prevent a relapse of alcoholic ketoacidosis.
The decreased insulin-to-glucagon ratio that occurs in starvation indirectly reduces the inhibition on CAT activity, thereby allowing more free fatty acids to undergo oxidation and ketone body formation. 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. If you have symptoms of alcoholic ketoacidosis, your doctor will perform a physical examination.
Workup in alcoholic ketoacidosis
Consequently, the patient essentially experiences total insulin lack. Because insulin is a key metabolic hormone, insulin deficiency leads to major impairment of the body’s regulation of carbohydrate, lipid, and protein metabolism. Once the diagnosis of alcoholic ketoacidosis (AKA) is established, the mainstay of treatment is hydration with 5% dextrose in normal saline (D5 NS) to address the principal physiologic derangement, a lack of metabolic substrate (glucose). Carbohydrate and fluid replacement reverse this process by increasing serum insulin levels and suppressing the release of glucagon and other counterregulatory hormones and by providing metabolic substrate.
- Conversely, long-term alcohol ingestion in diabetics who are not adequately nourished can lead to dangerously low blood sugar levels.
- Most healthy people with an adequate supply of food are not at risk.
- People interested in following specialized diets, such as the keto diet, should talk with their doctor before starting the diet.
- The mechanisms underlying the development of alcoholic ketoacidosis are complex.
- When you drink alcohol, your pancreas may stop producing insulin for a short time.
It should be suspected in any patient who has a history of chronic alcohol dependency, malnutrition or recent episode of binge drinking . Alcoholic ketoacidosis (AKA) is a condition seen commonly in patients with alcohol use disorder or after a bout of heavy drinking. It is a clinical diagnosis with patients presenting with tachycardia, tachypnea, dehydration, agitation, and abdominal pain. This activity illustrates the evaluation and treatment of alcoholic ketoacidosis and explains the role of the interprofessional team in managing patients with this condition. Accordingly, more studies are needed to determine whether the beneficial effects of daily moderate alcohol consumption outweigh the deleterious effects.
BOX 3 MANAGEMENT OF AKA
Neurologically, patients are often agitated but may occasionally present lethargic on examination. Alcohol withdrawal, in combination with nausea and vomiting, makes most patients agitated. However, if an AKA patient is lethargic or comatose, an alternative cause should be sought.
- During starvation, there is a decrease in insulin secretion and an increase in the production of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone.
- Lactic acidosis occurs when ethanol metabolism results in a high hepatic NADH/NAD ratio, diverting pyruvate metabolism towards lactate and inhibiting gluconeogenesis.
- Consequently, the patient essentially experiences total insulin lack.
- Similar symptoms in a person with alcohol use disorder Alcohol Use Alcohol (ethanol) is a depressant (it slows down brain and nervous system functioning).
- It is essential to administer thiamine before any glucose administration to avoid Wernicke’s encephalopathy preci[itation.
A requirement for any medications other than D5 NS and thiamine are uncommon. Fluid resuscitation, carbohydrate administration, and thiamine supplementation are the mainstays of treatment in alcoholic ketoacidosis (AKA). In contrast to diabetic ketoacidosis, the predominant ketone body in AKA is β-OH.
You can learn how to reduce your alcohol intake or eliminate it altogether. Joining a local chapter of Alcoholics Anonymous may provide you with the support you need to cope. You should also follow all of your doctor’s recommendations to ensure proper nutrition and recovery. Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care. The length of your hospital stay depends on the severity of the alcoholic ketoacidosis.