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Alcoholic Ketoacidosis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Increased production of ketone bodies due to:

    • Dehydration (nausea/vomiting, ADH inhibition) leads to increased stress hormone production leading to ketone formation

    • Depleted glycogen s...

Diagnosis

Signs and Symptoms

  • Dehydration

  • Fever absent unless there is an underlying infection

  • Tachycardia (common) due to:

    • Dehydration with associated orthostatic changes

    • Concurrent alcohol withdrawal

  • Tachy...

Treatment

Pre-Hospital

  • Supportive measures including IV access with 0.9 NS, oxygen, and cardiac monitoring

  • Search for historical clues that may suggest other etiologies such as toxic ingestions or diabe...

Follow-Up

Disposition

Admission Criteria

  • Persistent metabolic acidosis

  • Persistent signs of hypovolemia

  • Persistent nausea and vomiting

  • Abdominal pain of uncertain etiology

  • Comorbid illness requiring admissio...

Pearls and Pitfalls

  • Aggressive volume repletion with dextrose containing fluid is key.

  • Volume resuscitate with NS as necessary

  • Thiamine repletion

  • Monitor electrolytes before and after treatment.

  • Unrecogni...

Additional Reading

  • Cartwright  MM, Hajja  W, Al-Khatib  S, et al. Toxigenic and metabolic causes of ketosis and ketoacidotic syndromes. Crit Care Clin.  2012;28(4): 601–631.

  • Diltoer  M, Troubleyn ...

Codes

ICD9

276.2 Acidosis 

ICD10

E87.2 Acidosis 

SNOMED

  • 55571001 alcoholic ketoacidosis (disorder)

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