alcoholic ketoacidosis

Etiology

• alcoholism with alcoholic liver disease
  • follows episode of alcohol intoxication

Pathology

• ethanol is metabolized to acetic acid then to acetate
  • acetate feeds into citric acid cycle generating NADH
• increase in catecholamines -> lipolysis -> acetoacetate
  • NADH reduces acetoacetate to beta-hydroxybutyrate

Laboratory

• blood alcohol levels may be below legal limit for intoxication (< 80 mg/dL)
• basic metabolic panel
  • anion gap metabolic acidosis
  • serum bicarbonate low
• urine ketones may be negative

Management

• supportive care
  • 5% dextrose in normal saline (D5WNS)
    • not necessary to correct low serum bicarbonate
• treatment for alcoholism

More general terms

• ketoacidosis