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Ketoacidosis Associated with Alcoholism in Nondiabetic Subjects
- LEONARD J. LEVY, M.D.;
- JUDITH DUGA, M.D.;
- MEDHAT GIRGIS, M.D.; and
- EDWIN E. GORDON, M.D.
Abstract
Six episodes of metabolic acidosis in five nondiabetic, chronically alcoholic patients have been documented. All patients had a history of chronic alcoholism and appreciable alcohol intake before admission. Protracted vomiting and prolonged abstention from food were common features. The acidosis resulted from the accumulation of β-hydroxybutyrate, acetoacetate, and lactate in the blood plasma. The acidotic state was promptly corrected with intravenous fluids containing glucose, NaCl, and modest amounts of NaHCO3. Analysis of the plasma at admission showed low concentrations of insulin and extremely elevated free fatty acid and cortisol concentrations. It is postulated that increased ketone body synthesis in these patients is a direct consequence of enhanced release of free fatty acids from adipose tissue stores. Exaggerated lipolysis could be secondary to low levels of circulating insulin, to increased concentrations of plasma cortisol and growth hormone, or to the response of other lipolytic hormones.
Article and Author Information
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▸From the Diabetes and Metabolism Division, Department of Medicine, New York University Medical Center, New York, N.Y.
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Supported in part by U.S. Public Health Service Research Grant #AM-12404, National Institute of Arthritis and Metabolic Diseases, National Institutes of Health, Bethesda, Md. Dr. Gordon is a Career Scientist of the Health Research Council of the City of New York under contract I-551.
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▸Requests for reprints should be addressed to Edwin E. Gordon, M.D., New York University Medical Center, 550 First Ave., New York, N.Y. 10016.
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- Received September 15, 1972.
- Accepted September 29, 1972.
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