Alcoholic ketoacidosis (AKA) is a serious buildup of acids called ketones in the blood. It usually happens in people who drink heavily when a binge is followed by vomiting and not eating. AKA causes nausea, vomiting, belly pain and fast breathing, and it needs emergency hospital care.
Call 911 now if someone who has been drinking heavily has: – Vomiting that won’t stop, or can’t keep fluids down – Severe belly pain – Fast, deep or labored breathing – Confusion, extreme sleepiness or trouble waking up – Fainting, a racing heartbeat or a seizure Don’t wait to see if it passes. Alcoholic ketoacidosis can be life-threatening without treatment. For a mental health or suicide crisis, call or text 988.
Call (561) 340-7269 to talk with our admissions team.
What Is Alcoholic Ketoacidosis?
Your body normally runs on sugar (glucose). When it runs short, it burns fat instead, which makes acids called ketones. In small amounts, ketones are harmless.
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In alcoholic ketoacidosis, ketones build up so fast that the blood becomes too acidic. Doctors call this metabolic acidosis, and it can affect the heart, brain and other organs.
AKA almost always happens in people with a long history of heavy drinking, often with alcohol use disorder. It’s a sign that drinking has started to seriously affect the body. Learn the signs of alcohol addiction.
How AKA Differs From Other Emergencies
AKA can look like other alcohol-related emergencies. Hospitals run tests to tell them apart, but here’s how they generally compare:
| Condition | When it usually happens | Blood sugar | Breathing |
|---|---|---|---|
| Alcoholic ketoacidosis (AKA) | A day or more after a binge, once vomiting and not eating set in, often after drinking has stopped | Usually normal or low | Fast and deep |
| Diabetic ketoacidosis (DKA) | Mostly in people with diabetes when insulin is too low | Usually high | Fast and deep |
| Alcohol poisoning | During or soon after drinking a large amount | Can be low | Slow or irregular |
People with diabetes who drink heavily can develop either type of ketoacidosis, so tell the medical team about both. Read more about alcohol and diabetes and the signs of alcohol poisoning.
Alcoholic Ketoacidosis Symptoms
Symptoms often start one to three days after a stretch of heavy drinking, usually after the person has stopped drinking because they feel too sick. Because of this, someone with AKA may have little or no alcohol in their blood.
Common symptoms include:
- Nausea and repeated vomiting
- Belly pain
- Fast, deep breathing
- Fast heartbeat
- Signs of dehydration, such as extreme thirst, dry mouth, dizziness when standing and little or no urine
- Weakness and tiredness
- Agitation or confusion
Some of these symptoms overlap with alcohol withdrawal, which can start at the same time. Learn what to expect from the alcohol withdrawal timeline.
What Causes Alcoholic Ketoacidosis?
AKA usually results from several things happening together:
- Long-term heavy drinking. Over time, drinking changes how the liver handles energy.
- Not eating. Without food, the body’s stored sugar runs low within a day or so, and it turns to fat for fuel.
- Vomiting and dehydration. Losing fluids makes the acid buildup worse and harder for the body to clear.
- How the liver breaks down alcohol. Processing alcohol pushes the liver toward making ketones and away from making new sugar.
- Stress hormones. Illness and dehydration raise hormones that speed up fat breakdown, while insulin levels drop.
A typical pattern is several days of heavy drinking, then an upset stomach and vomiting, then no food and no alcohol. Pancreatitis, liver disease and past episodes of AKA can raise the risk.
How Hospitals Treat Alcoholic Ketoacidosis
AKA is treated in a hospital, and severe cases may need intensive care. Doctors first confirm the diagnosis and rule out other serious causes, such as diabetic ketoacidosis, pancreatitis, infection, or poisoning from methanol or antifreeze.
Treatment generally aims to restore fluids and stop ketone production. It often includes:
- IV fluids that contain sugar (dextrose) and salt
- Thiamine (vitamin B1), usually given before or with sugar to protect the brain from Wernicke encephalopathy
- Replacing minerals such as potassium, magnesium and phosphate
- Medicine to control nausea and vomiting
- Close watch for alcohol withdrawal, with treatment if it starts
Unlike diabetic ketoacidosis, AKA usually doesn’t need insulin treatment. With prompt care, many people improve within about a day, but AKA can be fatal without treatment and often comes back if heavy drinking continues.
Preventing Alcoholic Ketoacidosis
An episode of AKA is a serious warning sign. The main way to prevent another one is to stop drinking, with medical support.
- Talk to a doctor before you quit, since stopping heavy drinking suddenly can cause dangerous withdrawal
- Eat regular meals, and don’t go long stretches without food while drinking
- Get medical care if vomiting lasts more than a day or you can’t keep fluids down
- Ask about thiamine and other nutrition support
- Before you leave the hospital, ask the care team about next steps for alcohol treatment
Getting Help for Alcohol Use in Palm Beach County
If you or someone you love has been treated for AKA, this is a good time to get help with drinking. The Recovery Village Palm Beach at Baptist Health offers medical detox for alcohol at our Lake Worth campus, 4905 Lantana Rd., followed by intensive inpatient, residential, partial hospitalization (PHP) and intensive outpatient (IOP) care.
Your care team sets the length of stay based on your needs and plans aftercare with you before you leave. Meals are prepared by an executive chef in a full-service kitchen, which helps you get regular nutrition back on track. Our dual diagnosis care also treats depression, anxiety and other conditions that often come with heavy drinking.
We’re accredited by The Joint Commission and treat adults 18 and older. Learn more about alcohol addiction treatment.
Call (561) 340-7269 to talk with our admissions team.
Alcoholic Ketoacidosis FAQs
Is alcoholic ketoacidosis an emergency?
Yes. AKA needs emergency hospital care. It can cause dangerous changes in blood acid, fluids and minerals that affect the heart and brain.
Call 911 if someone who has been drinking heavily has repeated vomiting, severe belly pain, fast or deep breathing, confusion or fainting. Don’t try to treat it at home or wait for it to pass.
How long does alcoholic ketoacidosis last?
With prompt hospital treatment, AKA often improves within about a day. The hospital stay may be longer if the person also has alcohol withdrawal, pancreatitis, an infection or other problems. Recovering from the heavy drinking that caused it takes longer, and ongoing alcohol treatment can help lower the chance of another episode.
Can you die from alcoholic ketoacidosis?
Yes. AKA can be fatal, especially if treatment is delayed or if it happens along with other serious problems like severe dehydration, low potassium, infection or pancreatitis.
Many people recover with fast treatment, but the risk returns if heavy drinking continues. Call 911 at the first warning signs.
What is the difference between AKA and DKA?
Both cause a dangerous buildup of ketones. Diabetic ketoacidosis (DKA) happens mostly in people with diabetes when there isn’t enough insulin, and blood sugar is usually high.
Alcoholic ketoacidosis (AKA) follows heavy drinking plus vomiting and not eating, and blood sugar is usually normal or low. AKA usually doesn’t need insulin treatment, while DKA does.
Can alcoholic ketoacidosis happen again?
Yes. People who have had AKA once can have it again if heavy drinking continues.
Each episode is a sign that alcohol is causing serious harm to the body. Getting treatment for alcohol use, with medical detox if needed, is the main way to prevent another episode.
Who is at risk for alcoholic ketoacidosis?
AKA mostly affects adults with a long history of heavy drinking, especially after a binge followed by vomiting and not eating. Poor nutrition, pancreatitis, liver disease and past AKA episodes raise the risk.
It’s rare in people who drink lightly or only now and then. If you drink heavily, talk to a doctor about safe ways to cut back or stop.
