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| [[Alcoholic Ketoacidosis]] | | #REDIRECT[[Alcoholic Ketoacidosis]] |
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| == Background ==
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| *Seen in pts with recent h/o binge drinking with little/no nutritional intake
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| **Starvation leads to excess glucagon and decreased insulin
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| **Elevated NADH:NAD+ ratio due to ETOH metabolism
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| **Volume depletion from emesis & poor PO intake
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| *Characterized by high serum ketone levels and an elevated AG
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| **Consider other causes of elevated AG, as well as co-ingestants
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| **Concomitant metabolis alkalosis can occur from dehydration (volume depletion) and emesis
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| == Treatment ==
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| Consider associated diseases (ie pancreatitis, rhabdo, hepatitis, infections)
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| #Hydration - IVF should include 5% dextrose since there is a lack of glucose
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| #Thiamine (100mg IV/PO) prior to glucose to decrease risk of Wernicke encephalopathy or Korsakoff syndrome
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| #Oral nutrition if able to tolerate
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| #Electrolyte replacement - K, Mag and Phos
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| #Monitor for signs of alcohol withdrawal
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| #Consider bicarb if life-threatening acidosis (pH <7.1) unresponsive to fluid therapy
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| == Disposition ==
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| #Most go home after treatment if able to tolerate POs and acidosis resolved
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| #Consider admission for those with severe volume depletion and/or acidosis
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| :Hypoglycemia is poor prognostic feature, indicating depleted glycogen stores
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| == See Also ==
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| :[[Anion Gap (High)]]
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| :[[Acid-Base Disorders]]
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| [[Category:FEN]]
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