Sepsis and acute respiratory distress syndrome in alcoholic ketoacidosis.

Alcoholic ketoacidosis (AKA) is a syndrome characterized by metabolic acidosis with a large anion gap, malnutrition, and excessive alcohol intake in an alcoholic. AKA is commonly found in emergency units, especially in western countries, but it is seldom found in Indonesia, although the exact prevalence rate is still unknown. Acid base imbalance is different compared to metabolic acidosis with a large anion gap, and it is commonly found with metabolic alkalosis, hyperchloremic acidosis as well as respiratory alkalosis and lactic acidosis. Serum acetone was found in 96% patients. An increased alcohol level can be found and in 40% of cases with very toxic levels. Electrolyte imbalances such as hyponatremia, hypokalemia, hypophosphatemia, hyperglycemia, hypocalcemia, hypomagenesemia are also commonly found. The most common symptoms are nausea, vomiting, and stomachache. Physical examinations often show tachycardia, tachypnea, and stomachache. AKA occur commonly in alcoholics. There is no difference among different sexes or races. The pathophysiology of AKA is very complex. Its main trigger is closely associated with low insulin levels and excessive glucagon levels due to: 1. Malnutrition/low intake, causing glycogen storage depletion. 2. NAD (Nicotinamide Adenine Dinucleotide)/ NADH ratio increase, due to alcohol metabolism by alcohol dehydrogenase. 3. Low extracellular fluid. Relative insulin deficiency occurs due to glycogen storage depletion, decreased gluconeogenesis, and the effect of a-adrenergics on epinephrine. Increased NADH/NAD ratio influences gluconeogenesis, and both malnutrition and liver function abnormality affects the glycogen storage capacity. Reduced extracellular fluid stimulates the release of contraregulatory hormones such as growth hormone, cortisols, epinephrine, and glucagons. Insulin deficiency supports lypolysis and release of free fatty acids. Sepsis and Acute Respiratory Distress Syndrome in Alcoholic Ketoacidosis