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Alcoholic ketoacidosis
Medical expert of the article
Last reviewed: 04.07.2025
Alcoholic ketoacidosis is a metabolic complication of alcohol consumption and starvation, characterized by hyperketonemia and anion disturbances with metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is based on history and determination of ketoacidosis in the absence of hyperglycemia. Treatment consists of intravenous saline and dextrose.
[ Causes alcoholic ketoacidosis
Alcoholic ketoacidosis is caused by the combined effects of alcohol and fasting on glucose metabolism. Alcohol decreases hepatic gluconeogenesis and results in decreased insulin secretion, increased lipolysis, impaired fatty acid oxidation, and subsequent ketogenesis. Counterregulatory hormone levels are increased, and further inhibition of insulin secretion may occur. Plasma glucose levels are usually normal or decreased, but mild hyperglycemia may occasionally occur.
Typically, excessive alcohol consumption results in vomiting and cessation of alcohol or food intake for 24 hours or more. During this fasting period, vomiting continues, abdominal pain develops, and the patient seeks medical attention. Pancreatitis may develop.
Diagnostics alcoholic ketoacidosis
Diagnosis requires great care, the absence of hyperglycemia makes the diagnosis of diabetic ketoacidosis impossible. Routine laboratory tests reveal marked anion disturbances and metabolic acidosis, ketonemia, low levels of potassium, magnesium and phosphorus. Detection of acidosis may be complicated by concomitant metabolic alkalosis resulting from vomiting. Lactic acid levels are often elevated due to an imbalance of oxidation and reduction processes in the liver.
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Treatment alcoholic ketoacidosis
Treatment of alcoholic ketoacidosis begins with intravenous infusion of 5% dextrose in 0.9% saline with thiamine and other water-soluble vitamins and K as needed. Ketoacidotic and gastrointestinal symptoms usually resolve quickly. Insulin is needed only if atypical diabetic ketoacidosis is suspected or if hyperglycemia > 300 mg/dL develops.