醫學筆記匯整 ED Notes

- Severe ketoacidosis usually only occurs after ethanol ingestion has ceased.   
- 來醫院時 Blood ethanol levels at this time may be low or not detectable. 

- Ethanol 代謝成 acetic acid.
   The acetic acid may be exported from the liver to be utilized for energy or converted to acetyl-CoA. 
   所以不需要吃飯, 能量充足
   Dduring active ethanol ingestion,
   its metabolism generates acetate and acetyl-CoA,
   which inhibit peripheral lipolysis, and this limits fatty acid delivery to the liver. 
   When stop drinking, ethanol levels begin to fall causing a marked increase in lipolysis. 

 Clinical presentation

- Preceding section : Nausea, vomiting, and abdominal pain
   These symptoms typically develop at the end of the binge, 
   may be due to the acute effects of ethanol,
   esophagitis, gastritis, hepatitis, pancreatitis, or to an unrelated medical condition. 
   常合併 Alcohol 其他 complication 

- Increased respiratory rate,
  due to alcohol withdrawal, pain,
  respiratory compensation for metabolic acidosis.

- Patients with alcoholic ketoacidosis are usually alert and lucid despite severe ketoacidosis
   不像 DKA 意識不好

- Hypokalemia, Hypomagnesemia, hypophosphatemia are common in Alcoholic ketoacidosis.
  因為 N/V, Urine loss, malnutrition 

- Elevated serum osmolal gap : due to ethanol, serum acetone levels
 

 Diagnosis + Treatment 

- Ketoacidosis with a normal serum glucose
  History of ethanol abuse presents with a high AG metabolic acidosis
  Ketoacidosis with hyperglycemia is suggestive of diabetic ketoacidosis,
  but modest elevations in serum glucose can occur in alcoholic ketoacidosis

- In alcoholic patients, 100 mg of thiamine should be given prior to any glucose containing solutions. 
  In patients with hypoglycemia, glucose administration should not be delayed pending administration of thiamine,
  which should be given as soon as possible

- Administration of dextrose and saline solutions
  Administration of potassium, phosphate, and magnesium