Clinical features of alcoholic ketoacidosis with and without lactic acidosis: A retrospective descriptive study

Alcoholic ketoacidosis (AKA) is a potentially life-threatening condition due to high anion gap metabolic acidosis in chronic alcohol use. While lactic acidosis (LA) is typically uncommon in AKA, AKA without concurrent acute conditions is occasionally complicated with LA. The aim of this study was to clarify the clinical features in isolated AKA patients with LA and those without LA.

This retrospective study was conducted at a tertiary hospital between January 2021 and January 2024. We identified isolated AKA patients aged ≥20 years who presented with high anion gap metabolic acidosis, elevated ketones in serum or urine, and alcohol use disorder. Patients were classified into those with LA (lactate ≥4 mmol/L) and those without LA. We examined the clinical characteristics and outcomes in both groups and analyzed lactate trends during hospitalization in patients with LA.

Of 41 patients with AKA, 33 patients (80 %) had LA despite the fact that thiamine levels were similar in the two groups. Total ketone body and β-hydroxybutyrate levels in patients with LA were lower than those in patients without LA. Median lactate levels (10.7 mmol/L, IQR 7.7-14.5) in patients with LA decreased by approximately 1 mmol/L per hour during the first six hours post-admission. None of the patients died during hospitalization.

Isolated AKA is likely to be complicated with hyperlactatemia. Higher lactate levels tended to be observed in cases with lower ketone levels. Lactate levels in isolated AKA with LA declined steadily. Further studies are needed to confirm our findings.