Alcoholic ketoacidosis - Revision history

Blsimpso at 12:55, 23 July 2021

2021-07-23T12:55:23Z

← Older revision		Revision as of 12:55, 23 July 2021
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	*[[Anion Gap (High)]]		*[[Anion Gap (High)]]
	*[[Acid-Base Disorders]]		*[[Acid-Base Disorders]]

			==External Links==
			*[https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/alcoholic-ketoacidosis?query=alcoholic%20ketoacidosis Merk Manual - Alcoholic Ketoacidosis]
			*[https://www.emra.org/emresident/article/alcoholic-ketoacidosis/ EMRA - Alcoholic Ketoacidosis: Mind the Gap, Give Patients What They Need]

	==References==		==References==

Blsimpso: /* Disposition */

2021-07-18T14:59:59Z

Disposition

← Older revision		Revision as of 14:59, 18 July 2021
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	==Disposition==		==Disposition==
	*~~Discharge home after treatment if able to tolerate POs and acidosis resolved~~		*'''Admission'''
	*Consider admission for those with severe volume depletion ~~and~~/~~or acidosis~~		**Consider admission for those with severe volume depletion, acidosis, or persistent nausea/vomiting
	*[[Hypoglycemia]] is poor prognostic feature, indicating depleted glycogen stores		**[[Hypoglycemia]] is poor prognostic feature, indicating depleted glycogen stores
			*'''Discharge'''
			**Discharge home after treatment if able to tolerate POs and acidosis resolved

	==See Also==		==See Also==

Blsimpso: /* Evaluation */

2021-07-18T14:56:36Z

Evaluation

← Older revision		Revision as of 14:56, 18 July 2021
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	**BMP, Mg/phos		**BMP, Mg/phos
	***Often have concomitant [[electrolyte abnormalities]]		***Often have concomitant [[electrolyte abnormalities]]


	*'''ECG'''		*'''ECG'''
	**May show dysrhythmias or QT interval/QRS changes secondary to electrolyte abnormalities		**May show dysrhythmias or QT interval/QRS changes secondary to electrolyte abnormalities


	*'''Imaging'''		*'''Imaging'''

Blsimpso: /* Evaluation */

2021-07-18T14:55:48Z

Evaluation

← Older revision		Revision as of 14:55, 18 July 2021
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	==Evaluation==		==Evaluation==
	*[[Anion gap acidosis]]		*'''Labs'''
	**Typically ''wide'' anion gap		**[[Anion gap acidosis]]
	**Positive serum ketones + [[lactic acidosis]]		***Typically ''wide'' anion gap
	***Lab measured ketone is acetoacetate		***Positive serum ketones + [[lactic acidosis]]
	***May miss beta-hydroxybutyrate		****Lab measured ketone is acetoacetate
	***Urine ketones may be falsely negative or low		****May miss beta-hydroxybutyrate
	*Typically normal osmolal gap		****Urine ketones may be falsely negative or low
	*Alcohol level usually zero or not considerably high		**Typically normal osmolal gap
	*BMP, Mg/phos		**Alcohol level usually zero or not considerably high
	**Often have concomitant [[electrolyte abnormalities]]		**BMP, Mg/phos
			***Often have concomitant [[electrolyte abnormalities]]


			*'''ECG'''
			**May show dysrhythmias or QT interval/QRS changes secondary to electrolyte abnormalities


			*'''Imaging'''
			**Consider [[CXR]] if concern for aspiration pneumonia
			**Consider [[CT head]] if presentation associated with trauma

	==Management==		==Management==

Shihabali: /* Management */

2019-11-23T00:27:38Z

Management

← Older revision		Revision as of 00:27, 23 November 2019
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	**Prior to glucose to decrease risk of [[Wernicke encephalopathy]] or [[Korsakoff syndrome]]		**Prior to glucose to decrease risk of [[Wernicke encephalopathy]] or [[Korsakoff syndrome]]
	*Hydration (D5NS)		*Hydration (D5NS)
	**[[IVF]] should include 5% dextrose ~~since there is a lack of glucose~~		**[[IVF]] should include 5% dextrose to treat starvation ketosis
	**Large IVF admin does not predispose to cerebral edema		**Large IVF admin does not predispose to cerebral edema
	**Glucose stimulates insulin which stops lipolysis		**Glucose stimulates insulin which stops lipolysis

ClaireLewis: /* Management */

2019-09-28T22:17:42Z

Management

← Older revision		Revision as of 22:17, 28 September 2019
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	**K, Mag and Phos		**K, Mag and Phos
	*Monitor for signs of [[Alcohol Withdrawal\|alcohol withdrawal]]		*Monitor for signs of [[Alcohol Withdrawal\|alcohol withdrawal]]
	*Consider [[~~bicarb~~]] if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy		*Consider [[bicarbonate]] if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy

	==Disposition==		==Disposition==

ClaireLewis at 15:26, 28 September 2019

2019-09-28T15:26:07Z

← Older revision		Revision as of 15:26, 28 September 2019
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	*[[Vomiting]] (73%)		*[[Vomiting]] (73%)
	*[[Abdominal pain]] (62%)		*[[Abdominal pain]] (62%)
			*Typically, history of binge drinking ending in nausea, vomiting, and decreased intake
	*Not hyperosmolar as opposed to [[DKA]]		*Not hyperosmolar as opposed to [[DKA]]
	*Large IVF admin does not predispose to cerebral edema

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*~~Binge drinking ending in nausea, vomiting, and decreased intake~~		*[[Anion gap acidosis]]
	*Wide anion gap [[~~metabolic~~ acidosis]] ~~(ketonemia, [[lactic acidosis]])~~		**Typically ''wide'' anion gap
	*Positive serum ketones		**Positive serum ketones + [[lactic acidosis]]
	*Wide anion gap [[~~metabolic~~ acidosis]] ~~without alternate explanation~~		***Lab measured ketone is acetoacetate
	*~~Urine ketones may be falsely negative or low~~		***May miss beta-hydroxybutyrate
	**Lab measured ketone is acetoacetate		***Urine ketones may be falsely negative or low
	**May miss beta-hydroxybutyrate
	*Typically normal osmolal gap		*Typically normal osmolal gap
	*Alcohol level usually zero or not considerably high		*Alcohol level usually zero or not considerably high
			*BMP, Mg/phos
			**Often have concomitant [[electrolyte abnormalities]]

	==Management==		==Management==
Line 53:		Line 54:
	*Hydration (D5NS)		*Hydration (D5NS)
	**[[IVF]] should include 5% dextrose since there is a lack of glucose		**[[IVF]] should include 5% dextrose since there is a lack of glucose
			**Large IVF admin does not predispose to cerebral edema
	**Glucose stimulates insulin which stops lipolysis		**Glucose stimulates insulin which stops lipolysis
	*Oral nutrition if able to tolerate		*Oral nutrition if able to tolerate
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	**K, Mag and Phos		**K, Mag and Phos
	*Monitor for signs of [[Alcohol Withdrawal\|alcohol withdrawal]]		*Monitor for signs of [[Alcohol Withdrawal\|alcohol withdrawal]]
	*Consider bicarb if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy		*Consider [[bicarb]] if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy

	==Disposition==		==Disposition==

Beren85: /* Background */

2019-09-01T11:11:37Z

Background

← Older revision		Revision as of 11:11, 1 September 2019
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	*Characterized by high serum ketone levels and an elevated AG		*Characterized by high serum ketone levels and an elevated AG
	**Consider other causes of elevated AG, as well as co-ingestants (toxic alcohols, salicylates)		**Consider other causes of elevated AG, as well as co-ingestants (toxic alcohols, salicylates)
	**Concomitant [[Metabolic Alkalosis\|metabolic alkalosis]] can occur from dehydration (volume depletion) and emesis		**Concomitant [[Metabolic Alkalosis\|metabolic alkalosis]] can occur from dehydration (volume depletion) and emesis, so a normal blood pH may be found

	===Pathophysiology===		===Pathophysiology===

Sabedi: /* Management */

2018-10-22T02:40:54Z

Management

← Older revision		Revision as of 02:40, 22 October 2018
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	==Management==		==Management==
	Consider associated diseases (ie [[pancreatitis]], [[rhabdomyolysis]], [[hepatitis]], infections)		Consider associated diseases (ie [[pancreatitis]], [[rhabdomyolysis]], [[hepatitis]], infections)
	*[[Thiamine]] (100mg IV)		*[[Thiamine]] (100mg IV or IM)
	**Prior to glucose to decrease risk of [[Wernicke encephalopathy]] or [[Korsakoff syndrome]]		**Prior to glucose to decrease risk of [[Wernicke encephalopathy]] or [[Korsakoff syndrome]]
	*Hydration (D5NS)		*Hydration (D5NS)

Sabedi: /* Pathophysiology */

2018-10-22T02:39:32Z

Pathophysiology

← Older revision		Revision as of 02:39, 22 October 2018
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	*Ethanol metabolism depletes NAD stores<ref>McGuire LC, Cruickshank AM, Munro PT. Alcoholic ketoacidosis. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564331/ Emerg Med J. 2006 Jun;23(6):417-20.]</ref>		*Ethanol metabolism depletes NAD stores<ref>McGuire LC, Cruickshank AM, Munro PT. Alcoholic ketoacidosis. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564331/ Emerg Med J. 2006 Jun;23(6):417-20.]</ref>
	**Results in inhibition of Krebs cycle, depletion of glycogen stores, and ketone formation		**Results in inhibition of Krebs cycle, depletion of glycogen stores, and ketone formation
			**Suppresses gluconeogenesis and may result in hypoglycemia
	**High NADH:NAD also results in increased lactate production		**High NADH:NAD also results in increased lactate production
	***Lactate higher than normal but not as high as in shock or [[sepsis]]		***Lactate higher than normal but not as high as in shock or [[sepsis]]