• Brit Long, Skyler Lentz, and Michael Gottlieb.
• Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.
• J Emerg Med. 2021 Dec 1; 61 (6): 658-665.

BackgroundAlcoholic 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.ObjectiveThis narrative review evaluates the pathogenesis, diagnosis, and management of AKA for emergency clinicians.DiscussionAKA is frequently evaluated and managed in the ED. The underlying pathophysiology is related to poor glycogen stores and elevated nicotinamide adenine dinucleotide and hydrogen. This results in metabolic acidosis with elevated beta-hydroxybutyrate levels. Patients with AKA most commonly present with a history of alcohol use (acute or chronic), poor oral intake, gastrointestinal symptoms, and ketoacidosis on laboratory assessment. Patients are generally dehydrated, and serum glucose can be low, normal, or mildly elevated. 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.ConclusionsEmergency clinician knowledge of the evaluation and management of AKA is essential in caring for these patients.Published by Elsevier Inc.

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