Alcoholic Ketoacidosis: Causes, Symptoms, and Diagnosis

alcoholic ketoacidosis smell

Hormone-sensitive lipase is normally inhibited by insulin, and, when insulin levels fall, lipolysis is up-regulated, causing release of free fatty acids from peripheral adipose tissue. 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. Recognizing the impact of ketone bodies in acid-base homeostasis is pivotal in understanding the pathophysiology of AKA and guiding appropriate medical treatment to correct the underlying metabolic disturbances. Proper management often involves rehydration, electrolyte replacement, and nutritional support to arrest the progression of ketoacidosis and restore the body’s normal metabolic state.

When alcohol is consumed, it is rapidly absorbed from the gastrointestinal tract and disseminated throughout the body, primarily affecting the liver where it undergoes metabolism. This process involves the conversion of alcohol to acetaldehyde, a highly toxic and reactive byproduct. Acetaldehyde contributes to tissue damage, oxidative stress, and the generation of reactive oxygen species (ROS), which can alter the redox state of liver cells, leading to a cascade of metabolic disturbances. 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.

  1. While ketosis refers to any elevation of blood ketones, ketoacidosis is a specific pathologic condition that results in changes in blood pH and requires medical attention.
  2. Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels.
  3. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream.
  4. Alcohol’s interference with lipid metabolism can prompt alcoholic steatosis, while its impact on carbohydrate metabolism can impair gluconeogenesis, further destabilizing blood glucose levels.
  5. Anyone who finds it difficult to reduce their alcohol consumption should ask a doctor for advice.
  6. They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones.

If a person’s breath smells like acetone — or nail polish remover — it may indicate that there are high levels of ketones in their blood. Understanding what makes someone addicted to alcohol can be the first step in helping a person seek treatment. Depending on how bad their alcohol dual diagnosis treatment in california addiction treatment abuse has been or if medically-assisted alcohol detox will be needed for withdrawal symptoms, entering into a treatment center may be a necessary option. Professional medical staff can assist in the difficult process of withdrawal, making the transition into sobriety less daunting.

Other sources of acetone

Treatment typically involves intravenous hydration with saline solution and dextrose to correct the metabolic imbalance, alongside addressing the underlying nutritional deficiencies and alcohol use disorder. If you are diagnosed with alcoholic ketoacidosis, alcohol and the adolescent brain national institute on alcohol abuse and alcoholism niaaa your recovery will depend on a number of factors. Seeking help as soon as symptoms arise reduces your chances of serious complications. Treatment for alcohol addiction is also necessary to prevent a relapse of alcoholic ketoacidosis.

alcoholic ketoacidosis smell

The next important step in the management of AKA is to give isotonic fluid resuscitation. Dextrose is required to break the cycle of ketogenesis and increase insulin secretion. The dextrose will also increase glycogen stores and diminish counterregulatory hormone levels.

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Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care. The length of your hospital stay depends on the severity of the alcoholic ketoacidosis. It also depends on how long it takes to get your body regulated and out of danger.

The toxicokinetics that are pertinent to the diagnosis of AKA include the rate of alcohol oxidation in the body. Ethyl alcohol oxidizes at a rate of 20 to 25 mg/dL per hour in most individuals. The accompanying lack of alcohol in the patient’s body and the fact that for some time, the only source of calories that a patient has is ethanol both contribute to the clinical syndrome that we see. Gum diseases, including gingivitis, can cause bad breath, but not breath that smells like acetone. Having diabetes can also make a person more likely to develop oral health problems.

Your doctor and other medical professionals will watch you for symptoms of withdrawal. Certain populations are predisposed to develop ketoacidosis including people with diabetes, people with a history of prolonged and heavy alcohol use, pregnant women, breastfeeding women, children, and infants. In this case, the body may produce ketones, and a condition called alcoholic ketoacidosis may develop. However, if there is too much glucose in the blood and too little in the cells — as can happen with diabetes — ketone levels can rise too high.

Ketone bodies are produced as an alternative energy source when glucose utilization is impaired, a common scenario in chronic alcohol users. However, excessive ketone body production leads to acidosis, the hallmark of AKA. During physical examination, healthcare professionals look for signs that are consistent with AKA, such as signs of dehydration and an alcoholic odor on the breath. The patient’s recent nutritional intake, particularly a history of poor oral intake or fasting, is also considered, as AKA often occurs after a period of relative starvation. Persistent vomiting and abdominal pain are common complaints that may be reported by the patient.

alcoholic ketoacidosis smell

These symptoms usually are attributed to alcoholic gastritis or pancreatitis. This goal can usually be achieved through the administration of dextrose and saline solutions (see Treatment). Wearing medical identification can help others know what to do in an emergency related to diabetes. While following the diet, a person should ensure that they consume enough liquids and electrolytes. Knowing about DKA and being able to recognize its symptoms can save a person’s life. The American Diabetes Association (ADA) advises people to not exercise if they have signs of DKA and to seek medical assistance immediately.


The biochemical cascade leading to AKA begins when the body’s energy reserves are depleted and it starts to metabolize fats as an alternative energy source, resulting in an overproduction of ketone bodies. Several factors contribute to the onset of AKA, including starvation-induced hypoinsulinemia—a deficiency of insulin in the blood—as well as the direct oxidation of alcohol to its ketone metabolites. The condition is further exacerbated by lipolysis, which releases free fatty acids into the bloodstream, and intravascular volume contraction. Additionally, it has been found that episodes of AKA are often triggered by a lack of oral nutrition over a period ranging from one to three days, particularly in individuals with a history of alcohol use disorder.

Chronic alcohol intake may result in a condition known as fatty liver disease, where the liver’s metabolism of fats is disrupted. This can cause an increase in fatty acid synthesis and a decrease in oxidation, leading to the accumulation of fat within liver cells. As the liver is a central organ in metabolic regulation, its impairment can have widespread effects, such as the promotion of ketone body production.

Why does my breath smell like acetone?

In contrast to diabetic ketoacidosis, the predominant ketone body in AKA is β-OH. Routine clinical assays for ketonemia test for AcAc and acetone but not for β-OH. Clinicians underestimate the degree of ketonemia if they rely solely on the results of laboratory testing. You can prevent alcoholic ketoacidosis by limiting your alcohol intake.

Most cases of AKA occur when a person with poor nutritional status due to long-standing alcohol abuse who has been on a drinking binge suddenly decreases energy intake because of abdominal pain, nausea, or vomiting. In addition, AKA is often precipitated are there drops to reverse eye dilation by another medical illness such as infection or pancreatitis. During starvation, there is a decrease in insulin secretion and an increase in the production of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone.

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