Quick Facts: Alcoholic Ketoacidosis

Among diabetics, the prevalence of neuropathy with obvious symptoms (i.e., symptomatic neuropathy) increases with increasing disease duration. That increase in prevalence was most apparent in patients with a disease duration of less than 4 years. Other researchers observed that the prevalence of neuropathy in type 1 diabetics increased in a linear fashion with the alcohol amount consumed (Mitchell and Vinik 1987). Those researchers also reported that diabetics who consumed more than eight standard drinks per week developed peripheral neuropathy faster than did diabetics who consumed eight or fewer drinks per week. Glycogen is a large molecule that consists of numerous glucose molecules and serves as a storage form of glucose in the tissues, particularly the liver. In the fasting state, as a first line of defense against hypoglycemia, glycogen is broken down into its constituent glucose molecules, which are secreted by the liver into the blood to maintain normal or near-normal blood sugar levels.

Your cells need insulin to use the glucose in your blood for energy. If they can’t use glucose because there’s not enough insulin, your body switches to another method to get energy — breaking down fat cells. You can prevent alcoholic ketoacidosis by limiting your alcohol intake. You can learn how to reduce your alcohol intake or eliminate it altogether.

Possible Complications of Alcoholic Ketoacidosis

Laboratory values were significant for hypomagnesemia and hypophosphatemia. Without enough insulin, the body begins to break down fat as fuel. If it’s left untreated, the buildup can lead to diabetic ketoacidosis. On physical exam, most of the patients with ketoacidoses present with features of hypovolemia from gastrointestinal or renal fluid and electrolyte losses.

LDL cholesterol is strongly related to cardiovascular disease and stroke and has been called “bad” cholesterol. Reduction of LDL cholesterol decreases a person’s likelihood of suffering a heart attack or stroke. LDL cholesterol levels tend to be lower in alcoholics than in nondrinkers (Castelli et al. 1977), suggesting that chronic alcohol consumption may have a beneficial effect on cardiovascular risk. However, Lin and colleagues (1995) reported that the LDL cholesterol in alcoholics exhibits altered biological functions and may more readily cause cardiovascular disease. The researchers found that the levels of vitamin E, an agent that in part is bound to LDL cholesterol and which may decrease the risk of cardiovascular disease, also are lower in alcoholics than in nonalcoholics.

What is alcoholic ketoacidosis?

Alcohol consumption can exacerbate the diabetes-related lipid abnormalities, because numerous studies have shown that heavy drinking can alter lipid levels even in nondiabetics. Alcohol can induce several types of lipid alterations, including elevated triglyceride levels in the blood (i.e., hypertriglyceridemia), reduced levels of low-density lipoprotein (LDL) cholesterol, and elevated levels of high-density lipoprotein (HDL) cholesterol. In contrast to chronic alcohol consumption in the fed state—which raises blood sugar levels, resulting in hyperglycemia—alcohol consumption in the fasting state can induce a profound reduction in blood glucose levels (i.e., hypoglycemia).

• The pathology of alcoholic ketoacidosis (AKA) is a condition that results from the overconsumption of alcohol.
• Consequently, both of the body’s mechanisms to sustain blood sugar levels are inactivated in people who consume alcohol but do not eat, resulting in profound hypoglycemia.
• You may have a difficult time living if you are suffering from alcoholic ketoacidosis because of a number of factors.

The majority of papers detected by this search focus primarily on diabetes mellitus and its complications, and were excluded. General literature reviews, single case reports, and letters were also excluded. All remaining papers were retrieved and the reference lists hand searched for any additional information sources.

What are the symptoms of alcoholic ketoacidosis?

When your body produces too much acid, your body can develop metabolic acidosis, which can cause unpleasant and potentially fatal conditions. Alcohol ketoacidosis can manifest as a variety of symptoms depending on how much alcohol is consumed, how much food is consumed, and how much hydration is provided. People who engage in chronic, excessive alcohol consumption after a binge drinking episode are more likely to develop this condition. Chronic alcoholic ketoacidosis is usually caused by frequent binge drinking and nausea, vomiting, and abdominal pain. Ketoacidosis, which occurs primarily in diabetics, is a condition characterized by excessive levels of certain acids called ketone bodies (e.g., acetone, acetoacetate, and β-hydroxybutyrate) in the blood.

• In normal alcohol metabolism, the ingested ethanol is oxidized to acetaldehyde and then to acetic acid with the enzyme alcohol dehydrogenase, during which process the coenzyme nicotinamide adenine dinucleotide (NAD+) is reduced to NADH.
• This typically occurs 8 to 16 hours after the initiation of treatment.2 Alcohol withdrawal in these patients should be aggressively managed with intravenous benzodiazepines.
• A person who isn’t eating properly and getting the nutrition the body needs from food because they’re drinking  heavy amounts of alcohol instead, starts to get a buildup of excessive amounts of ketones in the body.
• The researchers found that the levels of vitamin E, an agent that in part is bound to LDL cholesterol and which may decrease the risk of cardiovascular disease, also are lower in alcoholics than in nonalcoholics.
• The mechanisms underlying the development of alcoholic ketoacidosis are complex.

Generally, the glycogen supply is depleted after 1 or 2 days of fasting. Thus, a person who has been drinking alcohol and not eating for 1 or more days has exhausted his or her glycogen supply. Numerous studies have investigated alcohol’s effects on the control of blood sugar levels in diabetics. At this point, we were not confirmed about the cause of ketoacidosis since he was an alcoholic diabetic patient and presented with hyperglycemia alcoholic ketoacidosis smell which could be attributed to DKA or AKA. Before starting the treatment, we wanted to find out the cause of ketoacidosis in this patient since if it was AKA, starting insulin alone could lead to rapid hypoglycemia. To rule out AKA, we specifically asked about the alcohol intake and it was then revealed that he had binge alcohol intake during the last few days and had excessive vomiting which started around 10 to 12 hours back.

How Is Alcoholic Ketoacidosis Treated?

Starvation ketoacidosis occurs after the body is deprived of glucose as the primary source of energy for a prolonged time, and fatty acids replace glucose as the major metabolic fuel. Low insulin levels are seen inherently in as either an absolute or relative deficiency in type I diabetes or a relative deficiency with insulin resistance in type 2 diabetes. In alcoholic or starvation conditions, low insulin levels are secondary to absolute or relative hypoglycemia. This unfavorable ratio of insulin to glucagon activates hormone-sensitive lipase, which breaks down triglycerides in peripheral fat stores, releasing long-chain fatty acids and glycerol. The fatty acids undergo beta-oxidation in the hepatic mitochondria and generate acetyl-CoA.

Those observations suggest that the reduced levels of vitamin E in alcoholics actually may have harmful long-term effects. DKA occurs more frequently with type 1 diabetes, although 10% to 30% of cases occur in patients with type 2 diabetes,[2] in situations of extreme physiologic stress or acute illness. According to the morbidity and mortality review of the CDC, diabetes itself is one of the most common chronic conditions in the world and affects an estimated 30 million people in the United States. The clinical and biochemical features of AKA are summarised in boxes 1 and 2.