Quick Facts: Alcoholic Ketoacidosis

Management is based around exclusion of serious pathology and specific treatment for AKA where it is present. A possible link between AKA and sudden death in chronic alcoholism has been proposed but remains unconfirmed. Triglycerides stored in adipose tissue undergo lipolysis alcoholic ketoacidosis smell and are released into the circulation as free fatty acids bound ionically to albumin. Free fatty acids are removed by the liver, where they primarily undergo oxidation to hydroxybutyric acid and acetoacetate and subsequently are reesterified to triglyceride.

In a milder form, ketoacidosis may even occur in people who are fasting. In those people, insulin levels are diminished, because the fasting has considerably lowered their blood sugar levels, thereby depriving the pancreas of its stimulus to produce and secrete insulin. Insulin resistance does not immediately lead to overt diabetes, because the patient’s pancreatic beta cells initially can increase their insulin production enough to compensate for the insulin resistance. In fact, insulin-resistant people have higher than normal insulin levels (i.e., are hyperinsulinemic1). In time (i.e., probably after several years), however, the pancreas cannot keep up with the increased demand for insulin; although insulin production still may be higher than in nondiabetic people, it is no longer sufficient to overcome insulin resistance. Ultimately, insulin secretion declines even further, to levels below those seen in nondiabetics (although generally still higher than those seen in type 1 diabetics).


The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an alcohol use disorder. The test is free, confidential, and no personal information is needed to receive the result. It can be helpful to understand the basic guidelines for alcohol consumption so you can determine whether you are drinking above recommended levels and engaging in potentially harmful alcohol use. If you feel ill or stressed or you’ve had a recent illness or injury, check your blood sugar level often. You might also try a urine ketone test kit you can get at a drugstore.

When DKA is found in patients using SGLT2 inhibitors, it is often “euglycemic” DKA, defined as glucose less than 250. Therefore, rather than relying on the presence of hyperglycemia, close attention to signs and symptoms of DKA is needed. Wrenn et al found altered mental status in 15% of patients, attributable in all but one case to hypoglycaemia, severe alcohol intoxication, or infection. Fever was seen in only two patients, both with other likely underlying causes. Alcoholic ketoacidosis is a problem caused by drinking a lot of alcohol without eating food.

Diabetic Ketoacidosis

Cardiovascular disease, particularly myocardial infarction (heart attack), can rarely put people with diabetes at risk for DKA. However, DKA can worsen heart conditions and cause cardiopulmonary complications, including pulmonary edema and respiratory failure. Insulin allows glucose to pass from the bloodstream into body cells, where it is used for energy. When your cells don’t get the glucose they need, your liver begins to burn fat for energy instead. This process produces ketones, and when ketones are produced too quickly and build up, they can be toxic.

Those findings suggest that alcohol consumption, particularly moderate consumption, may have a protective effect against cardiovascular disease. Type 2 diabetes, which in most cases develops in people over age 40, has a somewhat different pathophysiology than type 1. People with type 2 continue to produce insulin in early disease stages; however, their bodies do not respond adequately to the hormone (i.e., the patients are resistant to insulin’s effects). Thus, insulin does not lower blood sugar levels to the extent that it does in people without diabetes. For example, obesity, inactivity, and cigarette smoking may worsen genetically determined insulin resistance. DKA usually develops slowly, but when vomiting occurs, this life-threatening condition can develop in a few hours.


The mechanisms underlying the development of alcoholic ketoacidosis are complex. However, some typical contributing factors result in insulin lack and excess glucagon levels, thereby promoting the development of ketoacidosis. As mentioned earlier in this article, poor food intake can lead to depleted glycogen levels.

  • As a result, those patients frequently have very low blood sugar levels (although some people with alcoholic ketoacidosis have very high blood sugar levels, because the lack of insulin prevents glucose uptake from the blood into the tissues).
  • All alcoholic patients presenting with acute illness should be offered contact with addiction services prior to or following discharge wherever possible.
  • Moreover, heavy drinking in a fasting state can cause hypoglycemia and ultimately increase diabetics’ risk of death from noncardiovascular causes.
  • In the fasting state, as a first line of defense against hypoglycemia, glycogen is broken down into its constituent glucose molecules, which are secreted by the liver into the blood to maintain normal or near-normal blood sugar levels.
  • The actions of insulin and glucagon must be finely balanced, because both lower than normal blood sugar levels (i.e., hypoglycemia) and higher than normal blood sugar levels (i.e., hyperglycemia) can have deleterious effects on the body.

Watch out for early signs of DKA, including thirst or a very dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. Seek emergency medical attention or call 911 immediately if you have these symptoms and suspect DKA. When the signal from insulin in the body is so low that glucose can’t go into cells to be used as a fuel source, the liver makes a huge amount of emergency fuel in ketones, and fat is broken down too rapidly for the body to process.

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