Ketoacidosis and trace amounts of isopropanol in a chronic alcoholic patient

Jessica B. Dwyer, Kenichi Tamama

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Alcohol ketoacidosis is a frequently missed diagnosis, but is well described in the literature. We present a case of ketoacidosis, likely alcohol ketoacidosis, in a 40 y-old chronic alcoholic patient. The detection of trace serum isopropanol prompted a discussion of alcohol ketoacidosis versus toxic isopropanol ingestion or a combination of both, including comparisons with citations in current literature. Methods: The automated instruments used to analyze the patient's urine, blood, and serum samples are described. Results: The initial impression was severe metabolic acidosis with an increased anion gap and normal serum glucose and whole blood lactate. Testing for potential toxic ingestions detected only increased serum acetone and trace serum isopropanol. A urinalysis positive for ketones and an increased serum β-hydroxybutyrate concentration clenched the diagnosis of ketoacidosis. Conclusion: Ketoacidosis with an increased anion gap in the absence of hyperglycemia or glycosuria in a chronic alcoholic patient should prompt the evaluation for alcohol ketoacidosis. Trace serum isopropanol may be worrisome for a toxic ingestion, but this finding in severe ketoacidosis may be explained by the reversible action of the enzyme alcohol dehydrogenase. Markedly increased serum isopropanol with a low serum acetone:isopropanol ratio would be more indicative of a toxic isopropanol ingestion.

Original languageEnglish (US)
Pages (from-to)245-249
Number of pages5
JournalClinica Chimica Acta
Volume415
DOIs
StatePublished - Jan 16 2013

Fingerprint

Ketosis
2-Propanol
Alcoholics
Poisons
Serum
Alcohols
Eating
Acetone
Acid-Base Equilibrium
Blood
Hydroxybutyrates
Alcohol Dehydrogenase
Glycosuria
Ketones
Urinalysis
Lactic Acid
Acidosis
Hyperglycemia
Blood Glucose
Glucose

Keywords

  • Acetone
  • Alcohol ketoacidosis
  • Isopropanol
  • Ketoacidosis
  • Metabolic acidosis
  • NADH:NAD ratio

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Ketoacidosis and trace amounts of isopropanol in a chronic alcoholic patient. / Dwyer, Jessica B.; Tamama, Kenichi.

In: Clinica Chimica Acta, Vol. 415, 16.01.2013, p. 245-249.

Research output: Contribution to journalArticle

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