Diagnosis and Treatment of Alcoholic Ketoacidosis (AKA)

Diagnostic Criteria

Alcoholic ketoacidosis is diagnosed by clinical history of alcohol abuse with recent cessation, high anion gap metabolic acidosis, plasma glucose ranging from hypoglycemic to mildly elevated, and elevated serum ketones, particularly β-hydroxybutyrate, as recommended by the American Diabetes Association 1, 2
High anion gap metabolic acidosis is calculated as [Na⁺] - [Cl⁻ + HCO₃⁻], with a typical arterial pH <7.3 and serum bicarbonate <18 mEq/L, according to the American Diabetes Association 1, 3, 4
Plasma glucose concentrations range from hypoglycemia to mildly elevated, rarely >250 mg/dl, as noted by the American Diabetes Association 1, 2
Diabetic ketoacidosis (DKA) is characterized by blood glucose >250 mg/dl, distinguishing it from AKA, as stated by the American Diabetes Association 3, 4
Starvation ketosis is differentiated from AKA by serum bicarbonate usually not lower than 18 mEq/L, as reported by the American Diabetes Association 1, 3

Isotonic saline (0.9% NaCl) at 15-20 ml/kg/h during the first hour is recommended for fluid resuscitation, followed by either 0.9% or 0.45% NaCl based on corrected serum sodium and hydration status, as suggested by the American Diabetes Association 3, 4
Potassium supplementation (20-30 mEq/L) is necessary once renal function is assured, according to the American Diabetes Association 3, 4
Frequent assessment of vital signs, fluid input/output, and mental status, as well as serial measurements of electrolytes, glucose, and acid-base status, are crucial for monitoring, as recommended by the American Diabetes Association 3, 5