S17C221 - Alcoholic ketoacidosis Flashcards Preview

Tintinalli Section 17 - Endocrine Emergencies > S17C221 - Alcoholic ketoacidosis > Flashcards

Flashcards in S17C221 - Alcoholic ketoacidosis Deck (7)
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1
Q

AK overview

A
  • WAGMA/HAGMA
  • assoc with cessation of EtOH
  • b/c of low glycogen reserves
  • results in increased ketoacids
  • can be seen in non-alcoholics
2
Q

AK: pathophys

A
  • EtOH metabolism uses NAD, it becomes depleted and results in inhibation of aerobic metabolism in the kreb cycle, depletion of glycogen stores, ketone formation and lipolysis stimulation
  • when glycogen stores are depleted insulin secretion is suppressed
  • increased catecholamines, glucagon, growth hormone which inhibits aerobic metabolism and stimulates lipolysis
  • acetyl coenzyme A from EtOH metabolism is converted to ketones (beta-hydroxy and acetoacetate)
  • beta-hydroxybutyrate predominates b/c not enough NAD to convert it to acetoacetate (AcAc)
  • there is also increased lactate production
3
Q

AK - Dx

A

CRITERIA

  • low, normal or only slightly elevated serum glucose
  • binge drinking ending in n/v, decr intake
  • WAGMA/HAGMA
  • positive serum ketones (however if not present this doesn’t exclude AK)
  • HAGMA w/o better explanation

other findings:

  • hypophos, hyponatremia, hypokalemia
  • AG is usually 16-33 mostly secondary to ketonemia
  • osmolal gap may be elevated from acetone but these pts are not hyperosmolar
4
Q

AK: symptoms

A
  • n/v
  • abdo pain
  • tachy, tachypnea
  • SOB, tremulous, hepatomegaly, aLOC, HoTN
5
Q

AK: Ddx

A
  • lactic acidosis
  • uremia
  • sepsis
  • ASA
  • toxic alcohols
  • DKA
  • starvation ketosis
  • concomitant dx: methanol, ethylene glycol, isopropronaol, pancreatitis, gastritis, UGIB, Sz, withdrawal, PNA, sepsis, hepatitis
6
Q

AK: Tx

A
  • hydrate with D5NS
  • giving sugar increases insulin and suppresses glucagon thereby reversing the AK and halting further ketone production
  • thiamine
  • replace lytes
  • give bicarb if severe and unresponsive to fluids and glucose
7
Q

AK: dispo

A

-may go home if acidosis resolved and pt can tolerate oral fluids