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Acute Med Surg. 2013 Dec 16;1(2):109-114. doi: 10.1002/ams2.13. eCollection 2014 Apr.

Alcoholic ketoacidosis that developed with a hypoglycemic attack after eating a high-fat meal.

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Department of Emergency Medicine Matsusaka Chuo Hospital Matsusaka Mie Japan.
Department of Hematology and Oncology Mie University Graduate School of Medicine Mie Japan.
Department of Gastroenterology Matsusaka Chuo Hospital Matsusaka Mie Japan.



Alcoholic ketoacidosis (AKA) usually occurs in patients with a history of prolonged alcohol abuse and recent binge drinking followed by abrupt cessation of alcohol consumption.


A 61-year-old man was brought to our emergency department. He had a history of eating barbecued beef with beer the previous night. He had unexplained hypoglycemia with high anion gap metabolic acidosis and fatty liver, and we strongly suspected AKA. After hydration with saline solution, dextrose, and thiamine, given i.v., his metabolic acidosis rapidly improved. A history of alcohol abuse and high serum β-hydroxybutyrate concentration were subsequently confirmed, and the diagnosis of AKA was finally made.


Our case suggests that a high-fat meal can induce AKA without abrupt cessation of alcohol consumption and that AKA should be considered when encountering patients with unexplained high anion gap metabolic acidosis with hypoglycemia and fatty liver, even if the past history of alcohol abuse is unknown.


Alcohol abuse; anion gap; consciousness disturbance; metabolic acidosis; β‐hydroxybutyrate

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