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Alcoholic Ketoacidosis

By Erika F. Brutsaert, MD, Assistant Professor;Attending Physician, Albert Einstein College of Medicine;Montefiore Medical Center

Alcoholic ketoacidosis is a complication of alcohol use and starvation that causes excess acid in the bloodstream, resulting in vomiting and abdominal pain.

People who go on a major alcohol binge often vomit repeatedly and stop eating. If the vomiting and starvation go on for a day or more, the liver's normal stores of sugar (glucose) decrease. The low glucose stores combined with lack of food intake cause low blood glucose levels. The low blood glucose levels decrease insulin secretion. Without insulin, most cells cannot get energy from the glucose that is in the blood. Cells still need energy to survive, so they switch to a back-up mechanism to obtain energy. Fat cells begin breaking down, producing compounds called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). This ketoacidosis is similar to the ketoacidosis that occurs in diabetes except that, unlike in diabetic ketoacidosis, blood glucose levels are low.


Symptoms of alcoholic ketoacidosis include

  • Excessive thirst

  • Nausea

  • Vomiting

  • Abdominal pain

Breathing tends to become deep and rapid as the body attempts to correct the blood’s acidity. Similar symptoms in a person with alcoholism may result from acute pancreatitis, methanol or ethylene glycol poisoning, or diabetic ketoacidosis. The doctor must exclude these other causes before diagnosing alcoholic ketoacidosis.


  • Blood and urine tests

Doctors base the diagnosis on the characteristic symptoms and their relation to alcohol abuse combined with laboratory test results that show increased amounts of ketones and acid in the bloodstream but normal or low blood glucose levels.


  • Thiamin and other vitamins and minerals given by vein

  • Intravenous saline and glucose

To treat alcoholic ketoacidosis, doctors give people thiamin (vitamin B1) by vein (intravenously) followed by intravenous saline and glucose solution. Other vitamins and minerals, such as magnesium, are added to the saline solution.