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What to Know About Alcoholic Ketoacidosis

Medically Reviewed by Dan Brennan, MD on June 07, 2021

Alcoholic ketoacidosis is a condition that can happen when you’ve had a lot of alcohol and haven't had much to eat or have been vomiting. When this happens, it can cause ketones, which are acids, to build up in your blood. If not treated quickly, alcoholic ketoacidosis may be life-threatening.

What Causes Alcoholic Ketoacidosis?

Alcoholic ketoacidosis is usually triggered by an episode of heavy drinking. This can cause you to vomit and stop eating. If you can't eat for a day or more, your liver will use up its stored-up glucose, which is a type of sugar. Your cells get their energy from glucose. When your liver uses up its stored glucose and you aren't eating anything to provide more, your blood sugar levels will drop. 

This drop in blood sugar causes your body to decrease the amount of insulin it produces. Your cells need insulin to use the glucose in your blood for energy. If they can't use glucose because there's not enough insulin, your body switches to another method to get energy — breaking down fat cells. 

Your fat cells break down and release ketones. Ketones are an acid. They provide some energy to your cells, but too much may cause your blood to become too acidic.

Who Is at Risk for Alcoholic Ketoacidosis?

Alcoholic ketoacidosis most commonly happens in people who have alcohol use disorder and chronically drink a lot of alcohol. But it can happen after an episode of binge drinking in people who do not chronically abuse alcohol. The risk is only related to alcohol abuse. Alcoholic ketoacidosis doesn't occur more often in any particular race or sex. It happens most often in people aged 20 to 60.

If you chronically abuse alcohol, you probably don't get as much nutrition as your body needs. Going on a drinking binge when your body is in a malnourished state may cause abdominal pain, nausea, or vomiting. Infection or other illnesses such as pancreatitis can also trigger alcoholic ketoacidosis in people with alcohol use disorder.   

What Are the Symptoms of Alcoholic Ketoacidosis?

The symptoms of alcoholic ketoacidosis are similar to symptoms of other conditions. This can make it hard to diagnose. Generally, symptoms can include:

How Is Alcoholic Ketoacidosis Diagnosed?

Your doctor will talk to you about your symptoms and your history, especially your history of alcohol use. Because the symptoms of alcoholic ketoacidosis are similar to other conditions, your doctor will have to rule out other problems. Your doctor may do lab tests which include:

How Is Alcoholic Ketoacidosis Treated?

The treatment for alcoholic ketoacidosis will depend on how severe it is and if you have any other problems along with it. You will probably be treated in the emergency room, but you may need to be admitted to the hospital for continued treatment. Some treatment options may include:

  • Intravenous thiamine, which is vitamin B1
  • Intravenous dextrose, which is a type of sugar
  • Intravenous fluid
  • Replacement of potassium, phosphorus, and magnesium, as needed
  • Treatment of any other conditions you may also have, such as pancreatitis
  • Medicines to help with alcohol withdrawal
  • Medicines to help with nausea

Possible Complications of Alcoholic Ketoacidosis

If alcoholic ketoacidosis is not treated completely or if treatment is delayed, the possible complications include: 

What Is the Prognosis for Alcoholic Ketoacidosis?

The prognosis for alcoholic ketoacidosis is good as long as it's treated early. However, the long-term prognosis depends on the severity of the underlying alcohol abuse disorder. The major causes of death in people with alcoholic ketoacidosis are diseases that occur along with the alcoholic ketoacidosis and may have caused it, such as pancreatitis, gastrointestinal bleeding, and alcohol withdrawal.

How Can Alcoholic Ketoacidosis Be Prevented?

You can prevent alcoholic ketoacidosis by limiting or stopping your use of alcohol. If you have alcohol use disorder, seek treatment to help you stop using alcohol. There are a variety of treatment options available for you to choose from, including:

Medication. There are currently three medications approved to help you stop drinking and reduce your chance of relapsing. These are naltrexone, acamprosate, and disulfiram. These medicines are not addictive and can be used in combination with other types of treatment.

Therapy or counseling. These behavior therapies focus on teaching you coping skills for changing your behavior. Therapy should be done by a licensed counselor and may include reinforcement and mindfulness techniques.

Support groups. Group meetings provide support for people trying to quit drinking. Meetings are widely available at little-to-no cost in most communities. Support groups can be a valuable source of support and can be combined with medication and therapy.

WebMD Medical Reference

Sources

SOURCES:

Alcohol and Alcoholism: "The Postmortem Diagnosis of Alcoholic Ketoacidosis."

EM Blog Mayo Clinic: "Alcoholic Ketoacidosis."

Howard, R.D., Bokhari, S.R.A. Alcoholic Ketoacidosis, StatPearls Publishing, 2021.

Medscape: "Alcoholic Ketoacidosis."

Merck Manual: "Alcoholic Ketoacidosis."

National Institute on Alcohol Abuse and Alcoholism: "Understanding Alcohol Use Disorder."

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