Alcoholic ketoacidosis: confused diagnosis

Area of Science:

• Internal Medicine
• Endocrinology
• Toxicology

Background:

• Diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) are critical conditions presenting with metabolic acidosis.
• DKA is typically associated with hyperglycemia, while AKA often presents with normal or low glucose levels.

Observation:

• A woman in her 30s presented with symptoms suggestive of DKA, including nausea, vomiting, abdominal pain, and significantly elevated serum glucose.
• Initial assessment indicated new-onset diabetes, but further investigation revealed the acidosis was due to alcohol consumption.

Findings:

• The patient's presentation mimicked DKA, but her elevated glucose was atypical for AKA.
• Diagnostic tests such as hemoglobin A1c, fructosamine, betahydroxybutyrate to acetoacetate ratio, C-peptide, and pancreatic beta-cell antibodies are crucial for differentiating between DKA and AKA.
• This case underscores that alcoholic ketoacidosis can occur with hyperglycemia, challenging typical diagnostic assumptions.

Implications:

• Accurate differentiation between DKA and AKA is vital for appropriate treatment and patient outcomes.
• Clinicians should consider alcoholic ketoacidosis in patients with unexplained ketoacidosis, even with elevated glucose levels.
• This case emphasizes the importance of a comprehensive diagnostic approach in metabolic emergencies.