A Case of Alcoholic Ketoacidosis Accompanied with Severe Hypoglycemia

Abstract

: We report a 55 year old Japanese man with a history of alcohol abuse, who was in a near fasting state for the previous few days. He was admitted to our hospital with abrupt disturbance of consciousness. He presented disturbance of consciousness with extreme hypoglycemia and ketoacidosis with high β-hydroxybutyric acid concentration. Taking into account his living history, we diagnosed with alcoholic ketoacidosis (AKA). Symptoms ameliorated with glucose injection and fluid loading. AKA patients show abdominal pain, nausea or vomiting, but they are usually alert and lucid despite the severe acidosis. This case, however, presented comatose status caused by hypoglycemia. Poor oral intake of this patient was assumed to be the cause of hypoglycemia. Alcoholism may cause hypoglycemia accompanying with AKA, due to a low carbohydrate intake, the inhibition of gluconeogenesis, and reduced hepaticglycogen storage as seen in this case. Here, we report a case of AKA that demonstrated hypoglycemia with the literature review.

Alcoholic ketoacidosis: a case report and review of the literature

“…Although AKA can cause a modest elevation in serum glucose, significant hyperglycaemia in patients with metabolic acidosis, the presence of ketones and a suggestive history would make DKA the more likely diagnosis. The clinical importance in recognizing AKA from DKA is demonstrated by cases of patients who were treated as DKA and developed severe hypoglycaemia as a result of inappropriate insulin administration [ 8 ].…”

“…The presence of a high anion gap, although not specific, is suggestive of AKA in a patient with an appropriate clinical history [ 9 ]. Additional measurements that may help determine the diagnosis of AKA include beta-hydroxybutyrate levels (high in AKA, low in DKA) and serum alcohol concentration (typically low or undetectable) [ 8 ]. The key principle of emergency management is adequate fluid resuscitation [ 10 ].…”

Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes

“…Oxidation of ethanol by hepatic alcohol dehydrogenase results in the increase of NADH and creates an imbalance favoring FFA conversion into ketones [113, 114]. Most commonly this condition is associated with normal blood glucose levels [111] but when accompanied with malnourishment (low carbohydrate intake) the patients become hypoglycemic and are rendered unconscious with potential brain damage [115, 116]. Though the hormonal profile of these patients is similar to those with DKA (low insulin and high counter regulatory hormones), their biochemical and metabolic profile varies quite a bit [117].…”

Urine ketone bodies and adverse outcomes in patients with acute ischemic stroke or TIA

“…Most commonly this condition was associated with normal blood glucose levels. However, the patients may become hypoglycemic and are rendered unconscious with potential brain damage when accompanied with malnourishment (low carbohydrate intake) [ 23 , 24 ], which indicated the potential negative effect of ketone bodies on nervous system in non-diabetic patients. Thus ketoacidosis may contribute to the pathology of adverse outcomes after stroke.…”