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  • Alcoholic ketoacidosis (also known as metabolic acidosis) is an acid-base disorder where the ketones in the blood build-up due to heavy alcohol intake. It’s a serious disorder that can be fatal if the symptoms become too severe or if it’s not treated properly.

    Causes Of Alcoholic Ketoacidosis

    Your body burns fat to make energy and the byproduct of that process is ketones. They are made by the liver with the help of free fatty acids and released into your fatty tissue. It’s a normal function. 

    But, if your body is not producing insulin or not enough insulin, those ketones can build up in your bloodstream and lead to ketoacidosis.

    How does this relate to alcohol? Alcohol ingestion causes your pancreas to stop insulin secretion for a short period of time

    Excessive Alcohol Consumption

    When you have alcohol use disorder and are taking in large amounts of alcohol due to frequent binge drinking, the pancreas will continually stop making insulin, the ketones will build up, and alcoholic ketoacidosis can occur.

    Chronic alcohol use can also cause a depletion in the glycogen stores in the kidneys and lower how fast ethanol (alcohol) is metabolized in your system. This can reduce the amount of glucose available in your body and lead to hypoglycemia.


    Besides excessive alcohol consumption, not eating enough and vomiting due to alcohol use can also cause the body to reduce its production of insulin and lead to alcoholic ketoacidosis. 

    It can also result in a decreased amount of carbohydrates and protein in your body. This can bring on malnutrition and further worsen the symptoms of ketoacidosis.

    Symptoms Of Alcoholic Ketoacidosis

    There are many symptoms that occur with alcoholic ketoacidosis and they range in their severity. Some of the most common symptoms may include:

    • vomiting
    • abdominal pain
    • agitation
    • fast respiratory rate
    • smelling a “fruity” odor
    • confusion
    • decreased alertness
    • fatigue
    • slow movement
    • loss of appetite
    • nausea 
    • dizziness
    • lightheadedness
    • thirst

    Co-Occurring Conditions

    Someone with alcoholic ketoacidosis may also have other conditions that are associated with alcohol abuse, including:

    • pancreatitis
    • ​gastritis
    • hepatitis
    • ​metabolic alkalosis
    • liver disease
    • kidney disease
    • ulcers
    • ethylene glycol poisoning
    • coma
    • pneumonia
    • encephalopathy 

    Diagnosing Alcoholic Ketoacidosis

    If you have symptoms of alcoholic ketoacidosis, your doctor will likely perform a physical examination as well as multiple tests before they give you a final diagnosis. 

    Because alcoholic ketoacidosis can look like other things, they’ll likely do a differential diagnosis to see if the problem is alcoholic ketoacidosis or not. 

    Some disorders that can look like alcoholic ketoacidosis include:

    • diabetic ketoacidosis (DKA)
    • alcoholic ketosis
    • toxic alcohol intake
    • starvation ketosis
    • lactic acidosis

    Testing For Alcoholic Ketoacidosis

    Your doctor will run quite a few tests before they can be sure whether you have alcoholic ketoacidosis or not. Some of the tests they may conduct include: 

    • amylase and lipase tests
    • arterial blood gas test
    • anion gap calculation (measure sodium and potassium levels)
    • test for blood-alcohol levels
    • ​anion gap metabolic acidosis testing
    • blood chemistry panel
    • test for blood glucose levels
    • blood urea nitrogen (BUN) and creatinine tests
    • serum lactate test
    • serum electrolyte test
    • urine test

    Alcoholic Ketoacidosis Prevention 

    Preventing alcoholic ketoacidosis mainly involves limiting or quitting drinking altogether. Without alcohol, alcoholic ketoacidosis cannot occur. 

    Medical Detox For Withdrawal

    When quitting alcohol, you should at least seek help from a medical detox center. Alcohol withdrawal symptoms can be severe and it’s best if they are treated as they come on.

    Some of the symptoms that come with alcohol withdrawal and further exacerbate the ketoacidosis can include:

    • headaches
    • nausea
    • tremors
    • vomiting
    • anxiety
    • hallucinations
    • seizures
    • altered mental status
    • tachycardia

    Inpatient and outpatient care along with support groups like Alcoholics Anonymous can also help you quit and develop skills to stay sober.

    Treating Alcoholic Ketoacidosis

    Treatment for alcoholic ketoacidosis is usually given in the emergency department of the hospital. Your doctor will keep an eye on your vital signs like heart rate, blood pressure, blood glucose, and breathing. 

    They’ll also likely give you fluids through an IV to help with malnutrition, which may include:

    • thiamine
    • potassium
    • phosphorus
    • dextrose (given after the thiamine to avoid Wernicke’s encephalopathy)
    • magnesium

    You may also be admitted into intensive care if you need more care over a period of time.  How long you stay depends on the severity of your ketoacidosis and how long your body takes to get back to normal.

    If you or a loved one is struggling with alcohol use, call our helpline today. We can help you through the process of finding the best addiction treatment for you.

    Written by Ark Behavioral Health Editorial Team
    ©2023 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.

    Emergency Medicine Journal - Alcoholic ketoacidosis
    National Library of Medicine: MedlinePlus - Alcoholic ketoacidosis
    StatPearls - Alcoholic Ketoacidosis

    Medically Reviewed by
    Manish Mishra, MBBS
    on July 3, 2022
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