Alcoholic ketoacidosis

AKA Above-knee amputation alcoholic ketoacidosis all BCPP Board Certified Psychiatric Pharmacist... 

Alcoholics can also develop ketoaddosis. In alcoholic ketoacidosis, 3-hydroxybutyrate is the major ketone body produced because there is usually a high NADH/NAD ratio in the hver. The urinary nitroprusside test detects only acetoacetate and may dramatically underestimate the extent of ketosis in an alcoholic. 3-Hydroxybutyrate levels (P-hydroxybutyrate) should always be measured in these patients. 

Michiels JP, Dive A, Donckier J, Installe E. Reversible myocardial dysfunction in a patient with alcoholic ketoacidosis. Am J Emerg Med 1998 16 371-373. 

Alcoholic ketoacidosis Acid ingestion (hydrochloric acid or ammonium chloride)... 

Alcohol inhibits gluconeogenesis and some patients are prone to develop hypoglycaemia 6-36 hours after alcohol ingestion, especially if they are malnourished or fasted. A small number of these malnourished patients develop alcoholic ketoacidosis. 

Osmotic contrast dyes Propylene glycol Renal failure without dialysis Severe alcoholic ketoacidosis, diabetic ketoacidosis, or lactic acidosis... 

In any patient with an elevated anion gap, also check the osmolar gap a combination of elevated anion and osmolar gaps suggests poisoning by methanol or ethylene glycol. Note Combined osmolar and anion gap elevation may also be seen with severe alcoholic ketoacidosis and even diabetic ketoacidosis. 

Alcoholic ketoacidosis is characterized by anion gap metabolic acidosis and elevated levels of beta-hydroxybutyrate and, to a lesser extent, ace-toacetate. The osmolar gap may also be elevated, causing this condition to be mistaken for methanol or ethylene glycol poisoning. 

Alcoholic ketoacidosis. Treat with volume replacement, thiamine (see p 505), and supplemental glucose. Most patients recover rapidly. 

Feeney C et al Reversible blindness associated with alcoholic ketoacidosis pseudomethanol intoxicalion. J Emerg Med 1998 16(4) 597-599. (PMID 9696177] (A 49-year-old woman with severe metabolic acidosis and acute blindness which resolved with symptomatic treatment. Ethanol was 14.76 mmol/F, and there was no detectable methanol.)... 

B. Other useful laboratory studies include electrolytes, lactate, ethanol, glucose, BUN, creatinine, calcium, hepatic transaminases, urinalysis (for crystals and Wood s lamp examination), measured osmolality, arterial blood gases, and ECG monitoring. Serum beta-hydroxybutyrate levels may help distinguish ethylene glycol poisoning from alcoholic ketoacidosis, which may also cause increased anion and osmolar gaps. (Patients with alcoholic ke-... 

Endogenous volatile metabolites are normal by products of intermediate metabolites. Analysis of these metabolites is important in the diagnosis of certain disease states. An example of headspace gas chromatography analysis applied to these metabolites is the determination of ketone bodies (Seto, 1994). Ketone bodies are present in biochemical altered states known as diabetic ketoacidosis, related to diabetics and alcoholic ketoacidosis, a consequence of chronic abuse of alcohol. Studies (Iten Meier, 2000 Pounder, et al., 1998 Thomsen, et al., 1995) indicate that alcoholic ketoacidosis could be the cause of death in alcoholics, in cases of sudden and xmexpected death, where alcohol determination was negative and that an alcoholic ketoacidosis state can be diagnosed with the determination of ketone bodies in postmortem blood samples. Ketone bodies (acetone, acetoacetate and 3-hydroxybutyrate) can be measured separately by gas chromatography headspace. Acetone are determined at a headspace temperature below 60°C to avoid decarboxilation of... 

Iten, P.X. Meier, M. (2000). (3-Hidroxybutyric acid. An Indicator for an alcoholic ketoacidosis as cause of death in deceased alchol abusers. Journal of forensic Science. 45,3,624-632. 

Pounder, D.J. Stevenson, R.J. Taylor, KK (1998). Alcoholic ketoacidosis at autopsy. Journal of forensic science. 43, 812-816. 

Thomsen, J.L. Felby, S. Theeilade, P. Nielsen, E. (1995). Alcoholic ketoacidosis as a cause of death in forensic cases. Forensic Science International. 75,2-3,163-171. 

Complex relations exist between Mg and carbohydrate metabohsm. Diabetes is frequently associated with Mg deficit and insulin may play an important role in the regulation of intracellular Mg content by stimulating cellular Mg uptake. Hypomagnesemia is the most common ionic abnormality in alcoholism because of poor nutritional status and Mg malabsorption, alcoholic ketoacidosis, hypophosphatemia, and hyperaldosteronism secondary to liver disease. 

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