Alcoholic Ketoacidosis Medication

  • Author: George Ansstas, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: May 19, 2011
 

Medication Summary

Potassium repletion is indicated in hypokalemic patients and normokalemic patients with acidemia.

Magnesium repletion is indicated in all patients to help restore calcium and potassium homeostasis and to prevent alcohol withdrawal. Phosphate repletion is recommended only if severe hypophosphatemia is present. Thiamine repletion is indicated routinely to provide prophylaxis against the development of Wernicke encephalopathy.[12]

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Electrolyte Supplements, Parenteral

Class Summary

These agents are used to replenish electrolyte levels that have been depleted.

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Potassium acid phosphate (K-Phos)

 

Potassium is essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of intracellular tonicity and skeletal and smooth muscles, and maintenance of normal renal function. Gradual potassium depletion occurs via renal excretion through GI loss or because of low intake.

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Magnesium sulfate

 

Magnesium is a cofactor in enzyme systems involved in neurochemical transmission and muscular excitability.

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Potassium phosphate/sodium acid phosphate

 

Response to IV phosphorus supplementation is highly variable and is associated with hyperphosphatemia and hypocalcemia. Base the rate of infusion and the choice of initial dosage on the severity of the hypophosphatemia and on the presence of symptoms. IV preparations are available as sodium or potassium phosphate.

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Vitamins

Class Summary

Vitamins are essential for normal DNA synthesis and cell function.

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Thiamine (Vitamin B-1)

 

This vitamin is indicated for thiamine deficiency, including Wernicke encephalopathy syndrome.

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Contributor Information and Disclosures
Author

George Ansstas, MD  Chief Resident, Department of Internal Medicine, St Louis University Hospital; Assistant Professor, Department of Internal Medicine, St Louis University School of Medicine

George Ansstas, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Irina Robinson  MD, Fellow, Department of Endocrinology and Metabolism, University of New Mexico School of Medicine and Health Sciences Center

Irina Robinson is a member of the following medical societies: American Association of Clinical Endocrinologists and American College of Physicians

Disclosure: Nothing to disclose.

Sofya M Rubinchik, MD  Consulting Staff, Department of Behavioral Health, Lovelace Medical Center

Sofya M Rubinchik, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, American Neuropsychiatric Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

David S Schade, MD  Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center

David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS  Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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  5. Al-Sanouri I, Dikin M, Soubani AO. Critical care aspects of alcohol abuse. South Med J. Mar 2005;98(3):372-81. [Medline].

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  8. Iten PX, Meier M. Beta-hydroxybutyric acid -- an indicator for an alcoholic ketoacidosis as cause of death in deceased alcohol abusers. J Forensic Sci. May 2000;45(3):624-32. [Medline].

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  11. Ngatchu T, Sangwaiya A, Dabiri A, et al. Alcoholic ketoacidosis with multiple complications: a case report. Emerg Med J. Nov 2007;24(11):776-7. [Medline].

  12. Diltoer MW, Troubleyn J, Lauwers R, et al. Ketosis and cardiac failure: common signs of a single condition. Eur J Emerg Med. Jun 2004;11(3):172-5. [Medline].

  13. Yanagawa Y, Sakamoto T, Okada Y. Six cases of sudden cardiac arrest in alcoholic ketoacidosis. Intern Med. 2008;47(2):113-7. [Medline]. [Full Text].

  14. Umpierrez GE, DiGirolamo M, Tuvlin JA, et al. Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis. J Crit Care. Jun 2000;15(2):52-9. [Medline].

  15. Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. May 22 2003;348(21):2074-81. [Medline].

  16. Wootton-Gorges SL, Buonocore MH, Kuppermann N, et al. Cerebral proton magnetic resonance spectroscopy in children with diabetic ketoacidosis. AJNR Am J Neuroradiol. May 2007;28(5):895-9. [Medline]. [Full Text].

  17. Ferreri R. Treatment practices of diabetic ketoacidosis at a large teaching hospital. J Nurs Care Qual. Apr-Jun 2008;23(2):147-54. [Medline].

  18. Kugelberg FC, Jones AW. Interpreting results of ethanol analysis in postmortem specimens: a review of the literature. Forensic Sci Int. Jan 5 2007;165(1):10-29. [Medline].

  19. Kelly AM. The case for venous rather than arterial blood gases in diabetic ketoacidosis. Emerg Med Australas. Feb 2006;18(1):64-7. [Medline].

  20. Pounder DJ, Stevenson RJ, Taylor KK. Alcoholic ketoacidosis at autopsy. J Forensic Sci. Jul 1998;43(4):812-6. [Medline].

 
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