Ketoacidosis Associated with Alcoholism in Nondiabetic Subjects

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.