Metabolic acidosis in the alcoholic: a pathophysiologic approach

Area of Science:

• Toxicology
• Internal Medicine
• Biochemistry

Background:

• Ethanol metabolism in the liver presents unique biochemical challenges.
• Acute ethanol ingestion can lead to complex acid-base disturbances.

Purpose of the Study:

• To review acid-base abnormalities in patients with metabolic acidosis from acute ethanol ingestion.
• To examine the theoretical constraints of ethanol metabolism in the liver.

Main Methods:

• Literature review of acid-base balance and ethanol metabolism.
• Analysis of mixed acid-base disturbances in alcoholic patients.

Main Results:

• Alcohol-induced acidosis is a mixed disturbance, often involving lactic, keto, and acetic acidoses.
• Metabolic alkalosis from vomiting can be masked by bicarbonate loss.
• Reduced extracellular fluid (ECF) volume may contribute to alcoholic acidosis via relative insulin deficiency.

Conclusions:

• Treatment necessitates comprehensive electrolyte and thiamine replacement.
• Insulin should be reserved for severe acidemia.
• Diagnosis of alcoholic metabolic disturbance does not require ethanol detection on admission.