Hypoglycemic coma with ketoacidosis in nondiabetic alcoholics

Five nondiabetic, chronically alcoholic patients presented in a comatose state during a two month prospective study and were found to be ketoacidotic. All of the patients were men, 28 to 59 years old. The usual history was one of chronic heavy, daily alcohol consumption until one to three days before presentation, when persistent anorexia, abdominal distress, nausea and vomiting commenced, with abstention from food thereafter. The patients were found to be in hypoglycemic coma, with diaphoresis, tachypnea and tachycardia, and immediately awoke when intravenous infusion of glucose was started. Serum glucose ranged between 19 and 27 mg per dl, the average arterial pH was 7.19 and the mean anion gap was 25 mEq per liter. Reaction with Acetest tablets was positive for ketones in both serum and urine in three of the patients. Serum beta-hydroxybutyrate was elevated in the four patients in whom it was measured. Lactic acidosis was not present. All patients were managed with prolonged intravenous infusions of glucose and saline solutions, and within 12 to 18 hours they were feeling well and findings on serum chemistry studies were normal. Follow-up after three months showed no repeated difficulties. The combination of alcoholic ketoacidosis and hypoglycemic coma in nondiabetic persons has not been described in the literature as a clinical entity; it may, however, represent a common but unrecognized syndrome. Therefore, because of its potentially serious consequences and because treatment is simple and effective, this entity must be thought of in alcoholic patients with altered mental status.