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alcoholic ketoacidosis

Etiology: - alcoholism with alcoholic liver disease - follows episode of alcohol intoxication Pathology: - ethanol is metabolized to acetic acid then to acetate - acetate feeds into citric acid cycle generating NADH - increase in catecholamines -> lipolysis -> acetoacetate - NADH reduces acetoacetate to beta-hydroxybutyrate Laboratory: - blood alcohol levels may be below legal limit for intoxication (< 80 mg/dL) - basic metabolic panel - anion gap metabolic acidosis - serum bicarbonate low - urine ketones may be negative Management: - supportive care - 5% dextrose in normal saline (D5WNS) - not necessary to correct low serum bicarbonate - treatment for alcoholism

General

ketoacidosis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  2. Allison MG, McCurdy MT. Alcoholic metabolic emergencies. Emerg Med Clin North Am. 2014 May;32(2):293-301. Review. PMID: 24766933