Alcoholic ketoacidosis (AKA) can occur in the nondiabetic or diabetic who has a number of risk factors. Severe ketoacidosis can be a cause of death, especially if care is delayed.

Usual clinical features:

(1) alcoholic with excessive ethanol intake (binge) followed by abrupt cessation

(2) malnutrition and/or poor nutrition for several days, resulting in ketosis

(3) onset of nausea, vomiting, tachycardia and tachypnea with or without abdominal pain

(4) dehydration


The condition may have additional triggers for nondiabetic ketoacidosis - severe pancreatitis, sepsis, AMI, stroke, etc.


The patient may have a past history of previous episodes.


Laboratory features:

(1) anion-gap metabolic acidosis

(2) elevated serum lactate concentration

(3) elevated beta-hydroxybutyrate concentration

(4) hypokalemia

(5) hypophosphatemia

(6) ketonuria


Alcoholic ketoacidosis:

(1) may be misdiagnosed as diabetic ketoacidosis if hyperglycemia is present

(2) can overlap with diabetic ketoacidosis if the patient is diabetic

(3) may be mixed with alcohol withdrawal

(4) may be mixed with the refeeding syndrome

(5) may be associated with ingestion of methanol or other toxic alcohol

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