Alcoholic ketoacidosis

Alcoholic ketoacidosis is caused by very heavy alcohol use. It most often occurs in a malnourished person who drinks large amounts of alcohol every day.

Symptoms of alcoholic ketoacidosis include:

• Nausea and vomiting
• Abdominal pain
• Agitation, confusion
• Changed level of alertness, which may lead to coma
• Fatigue, slow movements
• Deep, labored, rapid breathing
• Loss of appetite
• Symptoms of dehydration, such as dizziness, lightheadedness, and thirst

Tests may include:

• Arterial blood gases (measures the acid/base balance and oxygen level in blood)
• Blood alcohol level
• Blood chemistries and liver function tests
• CBC (complete blood count), measures red and white blood cells, and platelets, which help blood to clot
• Prothrombin time (PT), measures blood clotting, often abnormal from liver disease
• Toxicology study (checking for other poisons in your body)
• Urine ketones

Treatment may involve fluids (salt and sugar solution) given through a vein. You may need to have frequent blood tests. You may get vitamin supplements to treat malnutrition caused by excessive alcohol use.

People with this condition are usually admitted to the hospital, often to the intensive care unit (ICU). Alcohol use is stopped to help recovery. Medicines may be given to prevent alcohol withdrawal symptoms.

Prompt medical attention improves the overall outlook. How severe the alcohol use is, and the presence of liver disease or other problems, may also affect the outlook.

This can be a life-threatening condition. Complications may include:

• Coma and seizures
• Gastrointestinal bleeding
• Inflamed pancreas (pancreatitis)
• Pneumonia

If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help.

Limiting the amount of alcohol you drink will help prevent this condition.

Ketoacidosis - alcoholic; Alcohol use - alcoholic ketoacidosis

Finnell JT. Alcohol-related disease. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 137.

O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 30.

Updated by: Jacob Berman, MD, MPH, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.