An anion gap metabolic acidosis with ketosis and electrolyte abnormalities are usually present on laboratory evaluation. Management includes fluid resuscitation, glucose and vitamin supplementation, electrolyte repletion, and evaluation for other conditions. Alcoholic ketoacidosis (AKA) is a clinical condition primarily affecting individuals with a history of chronic alcohol use or binge drinking. It often occurs during periods of poor oral intake and includes symptoms such as nausea and vomiting, abdominal pain, and dehydration source. A distinct feature of AKA is the fruity smell of the breath due to a build-up of ketones in the body.
Alcohol-Related Metabolic Emergencies
This process leads to the production of ketones, which, if present in high levels, can cause the onset of alcoholic ketoacidosis and its signature smell. When your body can’t get energy from glucose, it burns fat in its place. The fat-burning process creates a buildup of acids in your blood called ketones, which leads to DKA if untreated.
Comparison with Diabetic Ketoacidosis
If a person is already malnourished due to alcoholism, they may develop alcoholic ketoacidosis. This can occur as soon as one day after a drinking binge, depending on nutritional status, overall health status, and the amount of alcohol consumed. In some instances, doctors may also assess for lactic acidosis, a condition characterized by an excessive buildup of lactic acid in the bloodstream. Treatment approaches will depend on the specific diagnosis derived from these investigations, allowing healthcare providers to deliver tailored care. Conversely, when ketoacidosis is identified, but its origin is unrelated to alcohol, medical professionals may explore other diagnostic possibilities. This may involve conducting tests to rule out conditions such as starvation ketosis.
Why does my breath smell like acetone?
- If the breath of a person who does not have a diabetes diagnosis smells of acetone, they should see a doctor who can check for diabetes and other causes of the smell.
- In cases where alcohol consumption is suspected as the cause, doctors will consider this information alongside clinical symptoms.
- Without glucose to burn, the body enters a severe form of ketosis, releasing enough ketones into the blood that the ketones begin poisoning the person.
The diagnosis is often delayed or missed, and this can have potentially fatal consequences. There are a variety of non-specific clinical manifestations that contribute to these diagnostic difficulties. In particular, cases of AKA can be misdiagnosed as diabetic ketoacidosis (DKA).
- If you have diabetes, this scent can be a sign of diabetic ketoacidosis (DKA), a condition that can be fatal if not treated.
- When your body can’t get energy from glucose, it burns fat in its place.
- Following resuscitation, our patient had plasma electrolyte levels corrected, nutritional supplementation provided and completed an alcohol detoxification regimen.
- When your body burns fat for energy, byproducts known as ketone bodies are produced.
In addition to confusion and agitation, alcoholic ketoacidosis may progress to encephalopathy, which is a condition where the normal functioning of the brain becomes impaired. This impairment may present with memory loss, personality changes, or a general decline in cognitive abilities. If you or a loved one experience any of these neurological symptoms after heavy alcoholic ketoacidosis alcohol consumption, it is crucial to seek medical attention. If you have symptoms of alcoholic ketoacidosis, your doctor will perform a physical examination. They will also ask about your health history and alcohol consumption. If your doctor suspects that you’ve developed this condition, they may order additional tests to rule out other possible conditions.
We present a 64-year-old female who presented with generalized abdominal pain, nausea, vomiting and shortness of breath. Arterial blood gas analysis showed significant acidaemia with a pH of 7.10, bicarbonate of 2.9 mmol/l and lactate of 11.7 mmol/l. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis.
History and Physical
Drinking more water may help control the fruity scent, but there’s no way to prevent it while following these types of diets. In order to experience alcoholic ketoacidosis, a person often has to drink large quantities of alcohol, while also being malnourished. Learn more about fruity breath—including when your fruity breath should cause you to seek out medical attention. How severe the alcohol use is, and the presence of liver disease or other problems, may also affect the outlook. People with this condition are usually admitted to the hospital, often to the intensive care unit (ICU). Being able to distinguish AKA from DKA is essential for healthcare professionals because proper treatment depends on accurate diagnosis.
Liver Disease
Your body typically produces ketone bodies when breaking down fat for energy, but their levels can rise significantly if you consume a lot of alcohol and don’t eat enough. (2) This can rapidly lead to AKA, which may manifest even after a single binge-drinking episode, especially if you abstain from eating for an extended period. Alcoholic ketoacidosis (AKA) is defined by metabolic acidosis and ketosis in a patient with alcohol use. This is a common presentation in the emergency department (ED) and requires targeted therapies.
Posterior Reversible Encephalopathy Syndrome: A Narrative Review for Emergency Clinicians
If you have fruity breath because you are fasting or following a ketogenic diet, there’s not a lot that you can do to prevent fruity breath. Staying hydrated and brushing your teeth thoroughly can help make the smell less noticeable. If you need help creating a nutritional plan to help control your blood sugar levels, ask your healthcare provider for a referral to a registered dietitian. If you have been intentionally fasting or eating a ketogenic diet, fruity breath is not a cause for concern—it’s just a sign that your body has entered ketosis. As your body breaks down food and fat in different ways, it releases chemicals that are then expelled when you breathe out.
- As this happens, the liver releases ketones, including acetone, as byproducts.
- The presence of this smell in the breath of a person with a chronic alcohol use disorder could be a sign of alcoholic ketoacidosis.
- A more recent abstract from 2014 also agrees with the effectiveness of using a breath test to screen for blood glucose levels.
- Dehydration and volume constriction directly decrease the ability of the kidneys to excrete ketoacids.
- The greatest threats to patients with alcoholic ketoacidosis are marked contraction in extracellular fluid volume (resulting in shock), hypokalaemia, hypoglycaemia, and acidosis.
- It often occurs during periods of poor oral intake and includes symptoms such as nausea and vomiting, abdominal pain, and dehydration source.
Fever was seen in only two patients, both with other likely underlying causes. If you’re following your treatment plan and your ketone level is moderate or high, call your doctor right away for help. You should also contact your doctor if you don’t have diabetes and are worried about a lasting acetone scent. Emergency clinician knowledge of the evaluation and management of AKA is essential in caring for these patients. If you begin vomiting or have other symptoms of DKA, contact your healthcare provider immediately or go to the emergency room. Diabetic ketoacidosis, or DKA, is a complication of diabetes, especially type 1 diabetes.
