#Alcoholic Ketoacidosis
#Alcohol withdrawal
#Alcohol Abuse
#Hyperkalemia
-Pathophysiology of Alcoholic Ketoacidosis reviewed.
Alcoholic patient with a 2-day history of abd. pain, n/v, who has bee binge drinking and hasn’t eaten in days. Labs show a high anion gap, low bicarbonate, ketonemia, and normal glucose level.
Treatment:
-Thiamine before glucose in alcoholic patients: Thiamine 100 mg IV / IM. Ideally prior to any glucose-containing solutions.*
-Dextrose and Saline Solution. E.g. D5 NS. Be careful in patients with hypokalemia because that may stimulate insulin release and push more potassium into cells.
-Potassium administration. Treat any hypokalemia PO / IV only if present.
-Phosphate administration. If low, replace it. It may actually be high since acidosis promotes movement of phosphate out of cells.
-Magnesium administration. If depleted, replace IV.
*There have been some case studies that show that giving glucose first and then thiamine can precipitate (or if present exacerbate) Wernicke’s encephalopathy. However, the evidence is weak. If a patient is hypoglycemic, don’t wait to give thiamine first. Go ahead and give the glucose to treat their hypoglycemia.
References:
http://emedicine.medscape.com/article/116820-overview
Emerg Med J. 2006 Jun; 23(6): 417–420. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564331/