Alcoholic Ketoacidosis Clinical Presentation: History, Physical Examination, Complications Leave a comment

Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. This is why diagnosis and subsequent treatment can sometimes be challenging, but it’s crucial to receive a proper and timely diagnosis to obtain the correct treatment. If your breath smells like acetone — the same fruity scent as nail polish remover — it may be a sign of high levels of ketones (acids your liver makes) in your blood. It’s a problem mainly of type 1 diabetes but also can happen with type 2 if you get a serious condition called diabetic ketoacidosis (DKA). And it can happen for a few reasons not related to diabetes, including keto diets, fasting, and heavy drinking. A person who isn’t eating properly and getting the nutrition the body needs from food because they’re drinking  heavy amounts of alcohol instead, starts to get a buildup of excessive amounts of ketones in the body.

  • Causes of DKA can include being unwell, having an injury or surgery, having your period, or not taking enough insulin.
  • DSMS is an individualized plan that provides opportunities for educational and motivational support for diabetes self-management.
  • This test will provide information about your sugar levels to help determine whether you have diabetes.
  • The resulting increase in the NADH/NAD+ ratio inhibits hepatic gluconeogenesis and elevates the ratio of hydroxybutyric acid to acetoacetic acid.

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. These symptoms are similar to some of the nutritional ketosis side effects, which can make detecting diabetes problematic. This is why it’s always a good idea to consult with your doctor before starting a keto diet. If your urine doesn’t have the characteristic keto urine smell, and your breath doesn’t also smell, you may want to consider other reasons for your odoriferous pee. Even in the absence of ketones, being dehydrated can lead to smelly urine, so be sure to drink up.

Treatment[edit edit source]

Hypomagnesemia and hypophosphatemia are common problems seen on lab evaluation due to decreased dietary intake and increased losses. As mentioned above, the direct measurement of serum beta-hydroxybutyrate is more sensitive and specific than the measurement of urine ketones. Starvation ketoacidoses patients may again have multiple electrolyte abnormalities due to chronic malnutrition, along with vitamin deficiencies. The pH may not be as low as in DKA or AKA, and the glucose levels may be relatively normal. Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin.

alcoholic ketoacidosis smell

Therefore, rather than relying on the presence of hyperglycemia, close attention to signs and symptoms of DKA is needed. A more recent abstract from 2014 also agrees with the effectiveness of using a breath test to screen for blood glucose levels. DKA can cause the blood to become acidic and affect how the organs function.

Who is at risk?

It is not uncommon for the ingested ethanol to have already been metabolized, leading to low or normal serum levels when checked. In normal alcohol metabolism, the ingested ethanol is oxidized to acetaldehyde and then to acetic acid with the enzyme alcohol dehydrogenase, during which process the coenzyme nicotinamide adenine dinucleotide (NAD+) is reduced to NADH. The acetic acid can be shunted towards ketogenesis in favorable insulin/glucagon concentrations, which is seen in hypoglycemia. In addition to this, the increased NADH further suppresses gluconeogenesis and reduces free glucose, perpetuating ketogenesis.[6] After abrupt withdrawal, rising catecholamine levels as a bodily response cause lipolysis and ketosis. The high ratio of NADH to NAD+ also favors the reduction of acetoacetate to beta-hydroxybutyrate. Growth hormone, epinephrine, cortisol, and glucagon are all increased.

For over 50 years, we’ve been administering evidence-based treatments with a compassionate approach to help patients find lasting freedom from addiction. We’ll be with you for life, with various inpatient and outpatient services, including an alumni support network. To learn how you can start a journey toward recovery, contact us at Gateway Foundation today. Foods like onions or garlic or poor dental habits cause a strong odor in your mouth, which often gets better with simple lifestyle changes. Without enough insulin, the body can’t use sugar to make the energy it needs.


You should also contact your doctor if you don’t have diabetes and are worried about a lasting acetone scent. Take our free, 5-minute alcohol abuse self-assessment below if you think you or someone you love might be struggling with alcohol abuse. 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.

  • 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.
  • You might also try a urine ketone test kit you can get at a drugstore.
  • Ketone bodies are fat-derived fuels used by tissues at the time of limited glucose availability.
  • This can occur as soon as one day after a drinking binge, depending on nutritional status, overall health status, and the amount of alcohol consumed.
  • It’s also one of the first symptoms that doctors look for when they check for DKA.
  • He has spent the last 15 years working as a therapist and advocate, helping individuals and families navigate the complexities of eating disorders.

Acetone is a type of ketone, and it is the same fruity-smelling substance found in some nail polish removers.


Patients who appear significantly ill and those with positive ketones should have arterial blood gas and serum lactate measurements. When your body can’t get energy from glucose, it burns fat in its place. The Intermittent explosive disorder Symptoms and causes fat-burning process creates a buildup of acids in your blood called ketones, which leads to DKA if untreated. Fruity-smelling breath is a sign of high levels of ketones in someone who already has diabetes.

Joining a local chapter of Alcoholics Anonymous may provide you with the support you need to cope. You should also follow all of your doctor’s recommendations to ensure proper nutrition and recovery. It also depends on how long it takes to get your body regulated and out of danger. If you have any additional complications during treatment, this will also affect the length of your hospital stay. If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis. This can occur as soon as one day after a drinking binge, depending on nutritional status, overall health status, and the amount of alcohol consumed.

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