Alcoholic Ketoacidosis and Ketosis in the Emergency Room.

DOI 9 Citations 17 References Open Access
  • Yokoyama Masako
    Mitsukoshi Health and Welfare Foundation
  • Hori Shingo
    Department of Emergency & Critical Care Medicine, School of Medicine, Keio University
  • Aoki Katsunori
    Department of Emergency & Critical Care Medicine, School of Medicine, Keio University
  • Fujishima Seitarou
    Department of Emergency & Critical Care Medicine, School of Medicine, Keio University
  • Kimura Hiroyuki
    Department of Emergency & Critical Care Medicine, School of Medicine, Keio University
  • Suzuki Masaru
    Department of Emergency & Critical Care Medicine, School of Medicine, Keio University
  • Aikawa Naoki
    Department of Emergency & Critical Care Medicine, School of Medicine, Keio University

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Other Title
  • 救急患者におけるアルコール性ケトアシドーシスとアルコール性ケトーシスの検討

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Objective: We clarified the frequency and clinical features of alcoholic ketoacidosis (AKA) and alcoholic ketosis (AK) in the emergency room of a Japanese hospital. Subjects and Methods: 1) We prospectively evaluated blood gas analysis, serum ketones, and urine ketones by dipstick among alcohol-related disorders in 940 patients at the Department of Emer-gency and Critical Care Medicine at Keio University Hospital in 3 months. 2) We retrospectively evaluated AKA among alcohol-related disorders registered in a database of 27, 952 patients at the same Department in the last 11 years: AKA was defined as metabolic acidosis with either high serum ketones or positive dipstick of urine ketones in heavy drinkers. Results: 1) Alcohol-related disorders were found in 16 patients (1.7%). AKA was diagnosed in 2 of the 16 (13%). Seven of the 16 (43%) showed both ketosis and low ratio of serum acetoacetate/β-hydroxybutyrate. 2) Alcohol-related disorders were found in 210 patients (0.8%), out of whom 9 (4%) met the criteria of AKA. All AKA patients were men. The most commonly complaint was consciousness disturbance. Some 73% had hypoglycemia and 36% hypothermia. Dipstick test of urine ketones showed high false-negative results (55%) due to low ratio of serum acetoacetate/β-hydroxybutyrate. Conclusion: Intensive evaluation of blood gas and serum ketones among heavy drinking patients in the emergency room showed that AKA and AK are common disorders. The clinical features of AKA in this study were, in part, similar to those of alcohol-related sudden death syndrome.

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