Alcoholic ketoacidosis: an underdiagnosed entity

Abstract

Alcoholic ketoacidosis (AKA) is a common and underdiagnosed cause of metabolic acidosis in patients with an alcohol-related disorder. It is a cause of non-hypoxic hyperlactatemia and its identification is particularly interesting in order to not multiply medical exams. Indeed, AKA will be cured by a simple management. Clinically, patients have digestive signs such as nausea, vomiting and abdominal pain after a bout of heavy drinking following by few days of fasting. On clinical examination, they have no impairment of consciousness and most often have a relatively well-preserved general condition. Biologically, there is a metabolic acidosis with an elevated anion gap associated with electrolyte disturbances and moderate hyperlactatemia. The pathophysiology of this acidosis is complex and involves an accumulation of ketone bodies, lactate and acetate. This diagnosis is unknown and often delayed or missed while its identification is essential in order to not confuse it with diabetic ketoacidosis. In fact, insulin treatment is at major risk of hypoglycemia, sometimes fatal, in these malnourished patients. The treatment consists of vitamin therapy and the correction of hydro-electrolyte disorders. Insulin and bicarbonate infusion should be avoided. The evolution is favorable and the acidosis is corrected in a few hours after this treatment. The risk is the recurrence of episodes. The purpose of this article is to describe the clinical, biological and pathophysiology of AKA so that it will be better recognized and its management more quickly implemented.