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. AKA can be an unrecognized cause of patients presenting with a severe metabolic acidosis, including the presence of ketones. It should be suspected in any patient who has a history of chronic alcohol dependency, malnutrition or recent episode of binge drinking [1]. Ketoacidosis is a metabolic state caused by uncontrolled production of ketone bodies that cause a metabolic acidosis.
This Is What May Be Causing Your Fruity Breath
It is essential to administer thiamine before any glucose administration to avoid Wernicke’s encephalopathy preci[itation. If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized. Other electrolyte abnormalities concomitantly present with alcohol abuse and poor oral intake include hypomagnesemia and hypophosphatemia.
- If you’re intentionally fasting or following a ketogenic diet, you should expect fruity breath.
- If the body cannot get its energy from glucose, it starts burning fat for fuel instead.
- It is essential to differentiate AKA from DKA to ensure that inappropriate insulin administration does not occur.
- When your body can’t get energy from glucose, it burns fat in its place.
- Alcohol withdrawal, in combination with nausea and vomiting, makes most patients agitated.
Who Is at Risk for Alcoholic Ketoacidosis?
Acetaldehyde is metabolized further to acetic acid by aldehyde dehydrogenase. Both steps require the reduction of nicotinamide adenine dinucleotide (NAD+) to reduced nicotinamide adenine dinucleotide (NADH). Wearing medical identification can help others know what to do in an emergency related to diabetes. Anyone who finds it difficult to reduce their alcohol consumption should ask a doctor for advice. While following the diet, a person should ensure that they consume enough liquids and electrolytes. The ADA recommends testing for ketones every 4–6 hours when a person is ill, such as with a cold or the flu.
Ketosis From Your Diet
If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream. This buildup of ketones can produce a life-threatening condition known as ketoacidosis. We present a 64-year-old female who presented with generalized abdominal pain, nausea, vomiting and shortness of breath. Arterial blood gas analysis showed significant acidaemia with a pH of 7.10, bicarbonate of 2.9 mmol/l and lactate of 11.7 mmol/l. If you have diabetes and smell acetone on your breath, make sure to follow your doctor’s treatment plan. Most of the time, this means taking insulin, a medicine to control your blood sugar and stop ketosis from happening.
Signs and symptoms
If you can’t eat for a day or more, your liver will use up its stored-up glucose, which is a type of sugar. When your liver uses up its stored glucose and you aren’t eating anything to provide more, your blood sugar levels will drop. When diagnosing alcoholic ketoacidosis, it’s crucial to consider potential alternative explanations for a patient’s symptoms. Some conditions, such as alcoholic ketoacidosis diabetic ketoacidosis, share similar symptoms and lab results with AKA, making differential diagnosis necessary. When your body doesn’t receive adequate nutrients during episodes of starvation, it relies on stored fat for energy. This process leads to the production of ketones, which, if present in high levels, can cause the onset of alcoholic ketoacidosis and its signature smell.
- Diabetes happens when your blood glucose (blood sugar), a key energy source from food, is too high.
- Diabetes is not the only condition linked to breath that smells of acetone.
- AKA typically presents with a severe metabolic acidosis with a raised anion gap and electrolyte abnormalities, which are treatable if recognized early and appropriate management instituted.
- The patient might be tachycardic, tachypneic, profoundly orthostatic, or frankly hypotensive as a result of dehydration from decreased oral intake, diaphoresis, and vomiting.
Breathing tends to become deep and rapid as the body attempts to correct the blood’s acidity. Similar symptoms in a person with alcohol use disorder may result from acute pancreatitis, https://ecosoberhouse.com/ methanol (wood alcohol) or ethylene glycol (antifreeze) poisoning or diabetic ketoacidosis. The doctor must exclude these other causes before diagnosing alcoholic ketoacidosis.
Often, blood alcohol levels are no longer elevated when patients present with alcoholic ketoacidosis. Growth hormone, epinephrine, cortisol, and glucagon are all increased. Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. One of the health problems related to alcohol abuse is pancreatitis, which is inflammation of the pancreas. Pancreatitis can disrupt the normal functioning of your digestive system and contribute to the development of alcoholic ketoacidosis. Alcoholic ketoacidosis is a metabolic condition resulting from excessive alcohol consumption.
Complications and Prognosis of Alcoholic Ketoacidosis Smell
- If you begin vomiting or have other symptoms of DKA, contact your healthcare provider immediately or go to the emergency room.
- Knowing about DKA and being able to recognize its symptoms can save a person’s life.
- Treatment may involve fluids (salt and sugar solution) given through a vein.
- Generally, the physical findings relate to volume depletion and chronic alcohol abuse.