Moreover, volume depletion increases the concentration of counter-regulatory hormones, further stimulating lipolysis and ketogenesis. If you believe you are experiencing HHS, contact a healthcare provider or go to the emergency room immediately. Diabetic ketoacidosis, or DKA, is a complication of diabetes, especially type 1 diabetes. Although not specific to AKA, imaging tests such as abdominal ultrasound or CT scan might be ordered if the doctor suspects complications, like pancreatitis, which could contribute to your AKA symptoms.
- 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.
- The presence of a high anion gap, although not specific, is suggestive of AKA in a patient with an appropriate clinical history 9.
- The next important step in the management of AKA is to give isotonic fluid resuscitation.
- Antiemetics such as ondansetron or metoclopramide may also be given to control nausea and vomiting.
- This buildup of ketones can produce a life-threatening condition known as ketoacidosis.
Why does my breath smell like acetone?
Drinking more water may help control the fruity scent, but there’s no way to prevent it while following these types of diets. Laboratory analysis plays a major role in the evaluation of a patient with suspected alcoholic ketoacidosis. Being able to distinguish AKA from DKA is essential for healthcare professionals because proper treatment depends on accurate diagnosis.
Differential diagnosis
The patient should have blood glucose checked on the initial presentation. The next Halfway house important step in the management of AKA is to give isotonic fluid resuscitation. Dextrose is required to break the cycle of ketogenesis and increase insulin secretion.
Signs and symptoms
If you have been intentionally fasting or eating a ketogenic diet, fruity breath is not a cause for concern—it’s just a sign that alcoholic ketoacidosis smell your body has entered ketosis. Learn more about fruity breath—including when your fruity breath should cause you to seek out medical attention. Efficient and timely management can lead to enhanced patient outcomes in patients with AKA. However, after adequate treatment, it is equally essential to refer the patient to alcohol abuse rehabilitation programs to prevent recurrence and long-term irreversible damage from alcohol abuse. Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated.
One of the tests performed is a urine test to check for ketones present, which could indicate AKA. Another common laboratory test comes in the form of amylase and lipase tests that evaluate the functionality of your pancreas, as disorders such as pancreatitis can cause AKA. 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.
Long-term Alcohol Use Management
Patients typically present with non-specific features including nausea, vomiting and generalized abdominal pain. Vomiting and/or diarrhoea is common and can lead to hypovolaemia and potassium depletion. Signs of shock including tachycardia and hypotension can be complicated by overlap of alcohol withdrawal 2. Electrolyte abnormalities are common to this condition and can precipitate fatal cardiac arrhythmias 3, 4.
- This may include therapy, education, and support groups, to assist you in understanding the nature of addiction and adopting new coping mechanisms to maintain sobriety.
- Alcoholic ketoacidosis doesn’t occur more often in any particular race or sex.
If the body cannot get its energy from glucose, it starts burning fat for fuel instead. The process of breaking down fat for energy releases byproducts called ketones. Elevated cortisol levels can increase fatty acid mobilization and ketogenesis. Growth hormone can enhance precursor fatty acid release and ketogenesis during insulin deficiency. Catecholamines, particularly epinephrine, increase fatty acid release and enhance the rate of hepatic ketogenesis. If you’re intentionally fasting or following a ketogenic diet, you should expect fruity breath.
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.
How Can Alcoholic Ketoacidosis Be Prevented?
- Growth hormone can enhance precursor fatty acid release and ketogenesis during insulin deficiency.
- In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis.
- The low glucose stores combined with lack of food intake cause low blood glucose levels.
- Laboratory tests are essential in diagnosing alcoholic ketoacidosis (AKA).
In general, the prognosis for a patient presenting with AKA is good as long as the condition is identified and treated early. The major cause of morbidity and mortality in patients diagnosed with AKA is under-recognition of concomitant diseases (that may have precipitated the AKA, to begin with). These include acute pancreatitis, gastrointestinal bleeding, and alcohol withdrawal. Mortality specifically due to AKA has been linked to the severity of serum beta-hydroxybutyric acid in some studies.