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Alcoholic Ketoacidosis - Underrecognized Cause of Metabolic Acidosis in the Elderly Full Text
Clinical Geriatrics, 02/17/2010
Krishnamurthy M – AKA has to be in the differential diagnosis of an elderly patient presenting to the hospital with altered mental status and metabolic acidosis. There is increasing evidence that, rather than being benign and self–limiting, AKA may be a significant cause of mortality in patients with alcohol dependence. It has a characteristic clinical presentation occurring some time after termination of alcohol intake, often resulting in a negative blood alcohol level. Although not very well known, high osmolal gap is an important characteristic of AKA and is attributed mainly to acetone, glycerol, and acetone metabolites such as acetol and 1,2–propanediol. Because of the high osmolal gap in AKA, it is difficult at times to exclude the simultaneous presence of toxic alcohol. Given the potentially high morbidity and mortality of these intoxications, it is important for the clinician to have a high degree of suspicion for these disorders in cases of high anion gap metabolic acidosis, acute renal failure, or unexplained neurological disease so that treatment can be initiated early. Therefore, if clinical history is unreliable, it is safer to start hemodialysis.
