Transient total blindness associated with alcoholic ketoacidosis

Area of Science:

• Internal Medicine
• Toxicology
• Ophthalmology

Background:

• Methanol poisoning is a common cause of high anion gap metabolic acidosis and visual deficits.
• Alcoholic ketoacidosis (AKA) can also present with high anion gap metabolic acidosis, but vision loss is rarely reported.
• This case highlights a potential, albeit uncommon, ophthalmologic manifestation of AKA.

Observation:

• A 56-year-old male presented with sudden, complete blindness and high anion gap metabolic acidosis.
• Physical examination showed mydriasis without a pupillary light reflex.
• The patient had a history of chronic alcohol abuse and denied methanol ingestion.

Findings:

• Diagnosis of alcoholic ketoacidosis was confirmed by high ketone body concentration and clinical history.
• Treatment with fluid infusion, glucose, and vitamin B1 supplementation improved acidemia.
• The patient experienced a full recovery of visual acuity as acidemia resolved.

Implications:

• Alcoholic ketoacidosis should be considered in patients presenting with high anion gap metabolic acidosis and visual disturbances.
• Acute vision loss in AKA may be reversible with appropriate medical management.
• This case expands the known clinical spectrum of alcoholic ketoacidosis.