A case of alcoholic ketoacidosis that developed via a hypoglycemic attack after eating a high-fat meal

DOI 27 References
  • Suzuki Kei
    Department of Emergency Medicine, Matsusaka Chuo Hospital Department of Hematology and Oncology, Mie University Graduate School of Medicine Emergency Critical Care Center, Mie University Hospital
  • Tamai Yasuyuki
    Department of Gastroenterology, Matsusaka Chuo Hospital
  • Urade Shinji
    Department of Gastroenterology, Matsusaka Chuo Hospital
  • Ino Kazuko
    Department of Emergency Medicine, Matsusaka Chuo Hospital Department of Hematology and Oncology, Mie University Graduate School of Medicine
  • Sugawara Yumiko
    Department of Emergency Medicine, Matsusaka Chuo Hospital Department of Hematology and Oncology, Mie University Graduate School of Medicine
  • Katayama Naoyuki
    Department of Hematology and Oncology, Mie University Graduate School of Medicine
  • Hoshino Tamotsu
    Department of Emergency Medicine, Matsusaka Chuo Hospital

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  • 高脂肪食摂取後に低血糖発作を来したアルコール性ケトアシドーシスの１例

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Alcoholic ketoacidosis (AKA) usually occurs in patients with a history of prolonged excessive alcohol abuse and recent binge drinking followed by abrupt cessation of alcohol consumption. AKA patients usually visit a medical institution complaining of gastrointestinal symptoms. We report an atypical case of AKA presenting with consciousness disturbance after eating a high-fat meal. A 61-year-old man was brought to our emergency department by ambulance for suspicion of stroke owing to consciousness disturbance. He had a history of eating barbecued beef with beer the previous night. Because of his consciousness disturbance, the detailed medical history was uncertain. However, he had unexplained hypoglycemia with high anion gap metabolic acidosis and fatty liver, and we strongly suspected AKA. After hydration by intravenous administration of saline solution, dextrose and thiamine, his metabolic acidosis rapidly improved. A history of alcohol abuse and high serum β-hydroxybutyrate concentration were subsequently confirmed, and the diagnosis of AKA was finally made. Our case suggests that a high-fat meal can induce AKA without abrupt cessation of alcohol consumption and that AKA should be considered when encountering patients presenting with unexplained high anion gap metabolic acidosis with hypoglycemia and fatty liver, even if the past history of alcohol abuse is unknown.

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