Alcoholic ketoacidosis (AKA) is a specific group of symptoms and metabolic state related to alcohol use. Symptoms often include abdominal pain, vomiting, agitation, a fast respiratory rate, and a specific "fruity" smell. Consciousness is generally normal. Complications may include sudden death. AKA most commonly occurs in long term alcoholics and less commonly in those who binge drink. Onset is generally after a decreased ability to eat for a few days. Diagnosis is generally based on symptoms. Blood sugar levels are often normal or only mildly increased. Other conditions that may present similarly include other causes of high anion gap metabolic acidosis including diabetic ketoacidosis. Treatment is generally with intravenous normal saline and intravenous sugar solution. Thiamine and measures to prevent alcohol withdrawal are also recommended. Treatment of low blood potassium may also be required. Those who are affected are most frequently between the ages of 20 and 60. The condition was initially recognized in 1940 and named in 1971. Signs and symptoms Nausea, vomiting, and abdominal pain are commonly present and people may also have tachypnea, tachycardia, and hypotension. In contrast to diabetic ketoacidosis, people with alcoholic ketoacidosis are usually alert and lucid despite the severity of the acidosis. Causes Alcoholic ketoacidosis is caused by complex physiology that is the result of prolonged and heavy alcohol intake, usually in the setting of poor nutrition. Chronic alcohol use can cause depleted hepatic glycogen stores and ethanol metabolism further impairs gluconeogenesis. This can reduce glucose availability and lead to hypoglycemia and increased reliance on fatty acid and ketone metabolism. An additional stressor such as vomiting or dehydration can cause an increase in counterregulatory hormones such as glucagon, cortisol and growth hormone which may further increase free fatty acid release and ketone production. Ethanol metabolism can also increase blood lactic acid levels which may also contribute to a metabolic acidosis. Diagnosis Diagnosis is generally based on symptoms. An elevated anion gap metabolic acidosis and ketosis is the classic present. However, a mixed acid-base disorder may be present especially if vomiting is contributing to a hypochloremic alkalosis. The ketone which is present is mostly beta-hydroxybutyrate rather than acetoacetate resulting in only a weakly positive nitroprusside test. People usually do not present with high blood sugar or sugar in the urine. This can cause false negative results when testing urine ketones as they only measure acetoacetate. Ethanol level are often low or negative despite a