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Emergency medicine
Alcoholic ketoacidosis: confused diagnosis
  1. Patrick Carlsen Smith and
  2. Dana Neutze
  1. Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Patrick Carlsen Smith; patrick_c_smith{at}med.unc.edu

Abstract

A woman in her 30s presented with a 3-day history of nausea, vomiting and abdominal pain. She was found to be in ketoacidosis with an elevated serum glucose level of 18.2 mmol/L (328 mg/dL). Based on her initial presentation and test results, she was believed to have new onset diabetic ketoacidosis (DKA) from previously undiagnosed diabetes. Subsequently, she was found to have acidosis caused by acute or chronic alcohol consumption, even though her serum glucose was higher than would be typically expected with alcohol abuse. Alcoholic ketoacidosis usually has lower glucose levels as well as retained mental function when compared with DKA. A haemoglobin A1c, fructosamine level, betahydroxybutyrate to acetoacetate ratio, C-peptide and antibodies to pancreatic beta-cells can help rule out diabetes as the aetiology of the ketoacidosis. This patient was treated with fluids and electrolyte replacement, showed rapid improvement, received alcohol cessation resources and was discharged home.

  • Emergency medicine
  • Alcoholic liver disease
  • General practice / family medicine
  • Medical management
  • Fluid electrolyte and acid-base disturbances

https://doi.org/10.1136/bcr-2024-260627

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    Footnotes

    • Contributors DN and PCS were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. DN and PCS gave final approval of the manuscript. PCS accepts full responsibility as guarantor for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.