Together, those numbers represented 4.7% of all deaths total worldwide. Limiting the amount of alcohol you drink will help prevent this condition. With timely and aggressive intervention, the prognosis for a patient with AKA is good. The long-term prognosis for the patient is influenced more strongly by recovery from alcoholism. He rightly mentioned diabetes, hypothermia and starvation as possible differential diagnoses. I read with interest the article ‘The Postmortem Diagnosis of Alcoholic Ketoacidosis’ by Palmiere and Augsburger (2014).

Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis

All cases were selected among the medico-legal autopsies performed in our center from 2011 to 2013. The main criterion for selection was the availability of femoral blood, postmortem serum from femoral blood, cardiac blood, vitreous humor, urine and cerebrospinal fluid during autopsy. The cases included eight males between 49 and 69 years of age, with a mean age of 58.

History and Physical

It was first described in 1926 that there is an association between fatty changes within the liver due to alcohol and sudden (presumed) arrhythmic death [4,5]. These deaths typically occur in white males who are greater than 50 years old with a negative or low blood alcohol and the liver usually depicts fatty change alcoholic ketoacidosis rather than cirrhosis [6]. The mechanism of death is not fully understood, but thought to be due to a variety of metabolic disturbances triggered by massive ethanol intake and starvation [7] resulting in cardiac arrhythmia. Post mortems on these cases are essentially negative, showing only liver steatosis.

Patient Education

Acetic acid (an acyl group carrier) is linked with coenzyme A (a thiol) to produce Acetyl-CoA. The metabolism of alcohol itself is a probable contributor to the ketotic state. Alcohol dehydrogenase (ADH), a cytosolic enzyme, metabolizes alcohol to acetaldehyde in hepatocytes.

Alcoholic ketoacidosis: a cause of sudden death of chronic alcoholics

• All relevant ethical issues were identified and discussed with the local Ethical Committee.
• He rightly mentioned diabetes, hypothermia and starvation as possible differential diagnoses.
• 782 (60.5%) were male, 509 (39.4%) were female and one retrospective case was of unknown sex.

Additionally, glycated hemoglobin levels were measured and found to be normal in all cases. If you have symptoms of alcoholic ketoacidosis, your doctor will perform a physical examination. If your doctor suspects that you’ve developed this condition, they may order additional tests to rule out other possible conditions. 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.

• Free fatty acids are either oxidized to CO2 or ketone bodies (acetoacetate, hydroxybutyrate, and acetone), or they are esterified to triacylglycerol and phospholipid.
• Many patients with alcoholic ketoacidosis have been found to have extremely elevated concentrations of plasma free fatty acids, with mean levels much higher than those observed in patients with diabetic ketoacidosis (Levy et al., 1973; Cooperman et al., 1974; McGuire et al., 2006).
• The condition is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids.

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. The most common cause of ketoacidosis is diabetic ketoacidosis but can also be caused by alcohol, medications, toxins, and rarely, starvation. AKA can be an unrecognized cause of patients presenting with a severe metabolic acidosis, including the presence of ketones. It should be suspected in any patient who has a history of chronic alcohol dependency, malnutrition or recent episode of binge drinking [1]. Although AKA can cause a modest elevation in serum glucose, significant hyperglycaemia in patients with metabolic acidosis, the presence of ketones and a suggestive history would make DKA the more likely diagnosis.

Alcoholic ketoacidosis: Clinical and laboratory presentation, pathophysiology and treatment

The investigation of beta-hydroxybutyrate as a marker for sudden death due to hypoglycemia in alcoholics