Postmortem Diagnosis of Alcoholic Ketoacidosis Alcohol and Alcoholism

By | October 15, 2020

Treatment may involve fluids (salt and sugar solution) given through a vein. You may get vitamin supplements to treat malnutrition caused by excess alcohol use. Glucose comes from the food you eat, and insulin is produced by the pancreas. When you drink alcohol, your pancreas may stop producing insulin for a short time.

Given the early recognition of AKA and concurrent management, our patient had a good outcome. Your prognosis will be impacted by the severity of your alcohol use and whether or not you have liver disease. Prolonged used of alcohol can result in cirrhosis, or permanent scarring of the liver. Cirrhosis of the liver can cause exhaustion, leg swelling, and nausea. The resulting increase in the NADH/NAD+ ratio inhibits hepatic gluconeogenesis and elevates the ratio of hydroxybutyric acid to acetoacetic acid.

Recent articles about Alcoholic Ketoacidosis

These results may suggest the existence of underlying pancreatic and liver diseases, such as alcoholic hepatitis of fatty liver, not completely unexpected in chronic alcoholics. However, as observed by Michiue et al., increased pancreatic amylase and gamma glutamyl transferase in postmortem samples may also indicate leakages from respective tissues damaged by circulatory failure and hypoxia in the death process (Michiue et al., 2013). ConclusionSigns and symptoms of AKA can often be non-specific and should be considered in patients with recent cessation of heavy alcohol use with vomiting and metabolic derangements. An elevated INR in a patient with chronic alcoholism may be due to vitamin K deficiency, which has not been previously reported. Many of these symptoms can be dangerous, even fatal, so it’s important to seek medical attention right away if you suspect ketoacidosis. Sudden death due to alcoholic ketoacidosis is common among those who binge drink on an empty stomach or lose nutrients through vomiting.

Femoral blood samples were collected by aspiration with a sterile needle and a syringe from the femoral vein(s) during autopsy. Blood samples were drawn after clamping the vein(s) at the proximal end and lifting the lower limb(s) for several minutes. Femoral blood was stored in tubes containing sodium fluoride (for ethanol, acetone, acetoacetate, beta-hydroxybutyrate and isopropyl alcohol determination) and tubes containing ethylenediaminetetraacetic acid (for glycated hemoglobin determination).

What is the long-term outlook for alcoholic ketoacidosis?

Whilst a decreased conscious level may have been expected, our patient was lucid enough to report drinking one to two bottles of wine per day for the past 30 years, with a recent binge the day prior to admission. Efficient and timely management can lead to enhanced patient outcomes in patients with AKA. However, after adequate treatment, it is equally essential to refer the patient to alcohol abuse rehabilitation programs to prevent recurrence and long-term irreversible damage from alcohol abuse. Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

  • He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health.
  • Although the underlying pathophysiology is complex, a proper comprehension greatly aids in the diagnosis and management of this condition.
  • Patients are usually tachycardic, dehydrated, tachypneic, present with abdominal pain, and are often agitated.

There was initial concern for acute liver failure until the patient’s hepatic function panel returned and argued against this diagnosis. Warfarin overdose was also considered, although the patient repeatedly denied this and reports he did not have access to his medications. Further, vitamin K administration in our patient resulted in normalization of his INR. Alcoholic ketoacidosis (AKA) is a condition seen commonly in patients with alcohol use disorder or after a bout of heavy drinking. It is a clinical diagnosis with patients presenting with tachycardia, tachypnea, dehydration, agitation, and abdominal pain. This activity illustrates the evaluation and treatment of alcoholic ketoacidosis and explains the role of the interprofessional team in managing patients with this condition.

Stewart analysis unmasks acidifying and alkalizing effects of ionic shifts during acute severe respiratory alkalosis

Carnitine acyltransferase (CAT) transports free fatty acids into the mitochondria and therefore regulates their entry into the oxidative pathway. The decreased insulin-to-glucagon ratio that occurs in starvation indirectly reduces the inhibition on CAT activity, thereby allowing more free fatty acids to undergo oxidation and ketone body formation. Ketone production can be further stimulated in malnourished, vomiting patients or in those who are hypophosphatemic.6 Both conditions are seen commonly in alcoholic patients with alcoholic ketoacidosis. Pancreatic amylase activity and gamma glutamyl transferase were elevated in all subjects.

alcoholic ketoacidosis diagnosis

Excessive drinking damages the pancreas, impacting insulin production. When this happens, your cells will have to burn fat to produce energy. Having too many ketones in the bloodstream is known as a dangerous condition called ketoacidosis. As you might already know, those with type one diabetes are unable to produce enough insulin. Without insulin injections, they’re likely to end up in a state of ketoacidosis. CRP, IL-6 and IL-10 levels were increased in all individuals studied.

This case demonstrates the importance of considering AKA in the differential diagnosis of a patient presenting with non-specific symptoms, significant metabolic acidosis and a history of alcohol excess. It alcoholic ketoacidosis symptoms is essential to differentiate AKA from DKA to ensure that inappropriate insulin administration does not occur. The key tenants to management of AKA include fluid resuscitation and electrolyte correction.

Some of these otherwise unexplained cases concern sudden deaths in chronic alcoholics (Pounder et al., 1998; Teresiński et al., 2009). Alcoholic ketoacidosis (AKA) is a condition that presents with a significant metabolic acidosis in patients with a history of alcohol excess. The diagnosis is often delayed or missed, and this can have potentially fatal consequences. There are a variety of non-specific clinical manifestations that contribute to these diagnostic difficulties. In particular, cases of AKA can be misdiagnosed as diabetic ketoacidosis (DKA).

Cerebrospinal fluid was collected by aspiration using a sterile needle and a syringe by suboccipital puncture as soon as possible after arrival of the bodies at the morgue or from the lateral ventricles and cisternal space during autopsy. Post collection, cerebrospinal fluid was stored in blood-culture bottles (aerobic and anaerobic) and immediately incubated at 37°C. Urine samples were collected by bladder aspiration during the autopsy, stored in preservative-free tubes and frozen at −20°C until analysis. Since all cases selected for this study originated from forensic practice with deaths occurring outside the hospital, data on antemortem biochemical results were not available. Although the underlying pathophysiology is complex, a proper comprehension greatly aids in the diagnosis and management of this condition. Limiting the amount of alcohol you drink will help prevent this condition.

  • Albumin concentration was determined by the bromocresol green method.
  • If a patient has a concurrent illness or condition along with ketoacidosis, the next steps may need to be different.
  • KOL does not provide healthcare advice, medical diagnosis or treatment.
  • The major cause of morbidity and mortality in patients diagnosed with AKA is under-recognition of concomitant diseases (that may have precipitated the AKA, to begin with).
  • Calcium oxalate crystals in the urine also suggests ethylene glycol poisoning.

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