Alcoholic Ketoacidosis Clinical Presentation

Updated: Oct 05, 2022
  • Author: George Ansstas, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Patients with alcoholic ketoacidosis (AKA) almost always are alcoholics who, prior to the development of ketoacidosis, have engaged in a period of very heavy drinking, with subsequent abrupt cessation of alcohol consumption 1-2 days before presentation. Such presentations typically result from physical complaints, such as the following:

  • Nausea, vomiting, and abdominal pain (each found in 60-75% of patients)

  • Dyspnea, tremulousness, and/or dizziness (10-20% each)

  • Muscle pain, diarrhea, syncope, and seizure (1-8% each)

  • Hematemesis or melena

These symptoms usually are attributed to alcoholic gastritis or pancreatitis.

Example case of alcoholic ketoacidosis: A 35-year-old man who chronically abuses alcohol presents with abdominal pain and intractable emesis for the past 2 days. The pain and emesis developed after 5 days of heavy drinking. Since their onset, he stopped eating and drinking altogether. He complains of epigastric pain that radiates through to his back. He is afebrile, tachycardic, and borderline hypotensive. He is sleepy, but awakens easily to verbal stimuli.


Physical Examination

Generally, the physical findings relate to volume depletion and chronic alcohol abuse. Typical characteristics of the latter may include rhinophyma, tremulousness, hepatosplenomegaly, peripheral neuropathy, gynecomastia, testicular atrophy, and palmar erythema. The patient might be tachycardic, tachypneic, profoundly orthostatic, or frankly hypotensive as a result of dehydration from decreased oral intake, diaphoresis, and vomiting.

The patient's breath may carry the fruity odor of ketosis. Tachypnea in the form of the Kussmaul respiration varieties is usually present when the pH is less than 7.2. [9]

Hypothermia is common in AKA. A fever can be a sign of an underlying infectious process.

Abdominal tenderness consistent with a diagnosis of alcoholic liver disease, pancreatitis, gastritis, or peptic ulcer disease may be found on abdominal examination and may mimic an abdominal emergency. Hemoccult-positive stools may be present.

Mental status may be normal or slightly impaired as a result of derangements in electrolytes or vital signs. Severe obtundation; fixed, dilated pupils; and finally, death may occur.



Complications associated with AKA include the following:

  • Life-threatening arrhythmias

  • Cardiac arrest [13, 19]

  • Shock

  • Infection

  • Pulmonary edema

  • Delirium tremens