Merck Manual

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Alcoholic Ketoacidosis

By

The Manual's Editorial Staff

Last full review/revision Sep 2019
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What is alcoholic ketoacidosis?

Alcoholic ketoacidosis is a problem caused by drinking a lot of alcohol without eating food. It can happen to people who binge-drink alcohol.

What causes alcoholic ketoacidosis?

If you drink a large amount of alcohol, get sick to your stomach, throw up, and can't eat or drink for a day or more:

  • Your blood sugar (glucose) levels drop

  • Your body makes less insulin to help your cells use blood sugar for energy

  • Your cells start burning fat for energy instead

  • Broken down fat goes to the liver and is made into ketones (acids)

  • The acid level in your blood goes up

What are the symptoms of alcoholic ketoacidosis?

Symptoms include:

  • Extreme thirst

  • Feeling sick to your stomach

  • Throwing up

  • Belly pain

  • Deep, fast breathing

How can doctors tell if I have alcoholic ketoacidosis?

Doctors suspect alcoholic ketoacidosis from your symptoms and your alcohol use. To know for sure, doctors will do:

  • Blood and urine tests

How do doctors treat alcoholic ketoacidosis?

Doctors treat alcoholic ketoacidosis with:

  • Thiamin (a type of B vitamin), given by vein (IV)

  • IV fluids (containing glucose if the blood sugar is low) and electrolytes (minerals, such as sodium and potassium, that help with many important body functions)

  • Insulin only if your blood sugar goes too high with treatment

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