theprof - Thanks for answer re ketoacidosis

[peripathetic]

Thank you for response however my original question was untrue as I wanted to keep it simple (and protect the guilty).
In fact I am a carer looking after a diabetic who 'likes a drink'.
After a number of occasions when my' ward' lost all levels of response and on three occasions involving a visit to A&E (with one embarrassingly turning out to be just because of alcohol) I decided to attempt to distinguish between alcohol or diabetic causes.
I first bought a breathalyser - as this was apparently effected by ketones it was useless.
I have obtained now obtained a blood/glucose meter with a ketone testing facility.
After looking up the two types of ketoacidosis you mention I can only assume that the meter is useless UNLESS raised ketone levels WITH raised blood/sugar levels indicates a diabetic cause and raised ketone only an alcohol problem.
Does this fall within your area of expertise?

[theprof]

First of all, yes this does fall into my area of expertise as I’m a professor of biochemistry and this is a biochemistry question. However, although I can answer some of the clinical aspects of your question, a detailed clinical answer needs the expertise of a doctor and MrsProf happens to be a university reader ( one step below a professor) in medicine at my university medical school. I’ve run the question past MrsProf, so the answer I’m about to give is from both of us!

First of all, your account of the incidents with your client seems to point to a number of episodes of ketosis rather than ketoacidosis. Ketosis may be defined as the presence of abnormally high levels of ketones in the blood as a consequence of excessive breakdown of fats caused by the absence or deficiency of carbohydrates- - fats are broken down instead which in turn leads to the production of ketone bodies such as hydroxybutyrates and acetoacetates. Ketoacidosis is life-threatening and requires specific intensive medical treatment that you’ve not mentioned in your account.

The body is very good at regulating ketones under normal circumstances and because of this, doctor’s look for specific diagnostic criteria when they come across a patient presenting with ketosis. So what are these criteria? Well ketosis will occur in a patient with poorly controlled diabetes –you are best placed to know if this is the case with your client. It can also occur as a result of diabetic ketoacidosis, starvation for prolonged periods, certain specific poisoning, bulimia, anorexia, certain ether anaesthetics, some rare metabolic disorders and alkalosis (very high blood alkalinity). It can also occur sometimes during pregnancy due to inadequate carbohydrate and/or protein intake.

(continued)

[theprof]

Ketosis leads to ketonuria and a loss of potassium via urine. A typical patient with ketosis will complain of a headache, become drowsy and lethargic, have difficulty breathing and may go into a coma if medical help is not sought. Ketosis causes the blood pH to become acidic along with water loss, sodium and potassium depletion, confusion, nausea, vomiting and a host of other biochemical changes that may lead to coma and death if left untreated..

The breath of patients with ketosis smells of either acetone or something similar to amyl acetate, which is best described as like pear-drops or nail-varnish remover.

Unfortunately as far as you are concerned, alcoholic ketoacidosis will also give a positive result for ketones in the blood, as well as the other conditions mentioned, so it’s unsafe to draw any conclusions on the meter reading alone.

I’m afraid that the best you can do in these circumstances is to see if your client’s breath smells as I described above and go from there. It would be unsafe to use criteria and methods that the police use for example to test if someone is intoxicated as there are medical implications here that I don’t believe you should be prepared to take on your shoulders.

MrsProf and I are of the opinion that you should seek advice either from your client’s GP or from your line manager/social services as appropriate as there are issues here that may have grave implications for all concerned.