The typical biochemical findings in patients with alcoholic ketoacidosis (AKA) include increased anion gap metabolic acidosis, increased serum ketones, a low or normal plasma glucose concentration, an increased plasma lactate concentration, and normal or increased values for blood urea nitrogen and serum creatinine.
There are a few caveats to the laboratory findings described in this Clinical Case Study that are important to discuss. As mentioned in the case report, mixed acid– base imbalances can occur in patients with AKA owing to concurrent disease processes. Therefore, the serum pH will reflect the final balance of these factors and may not necessarily be low. Increased serum “ketones” are a trademark of AKA; however, the ratio of β-hydroxybutyrate to acetoacetate is markedly higher in patients with AKA than in those with diabetic ketoacidosis. Many laboratories use semiquantitative nitroprusside-based assays to rapidly measure ketones (e.g., Acetest). Nitroprusside-based tests are most sensitive for detecting acetoacetate and do not detect β-hydroxybutyrate. These tests may yield a low to moderate result in patients with AKA even when the β-hydroxybutyrate concentration is markedly increased. Electrolyte abnormalities, including hyponatremia and hypokalemia, are often present in patients with AKA, and hypokalemia is a strong indicator of hypomagnesemia. Potassium and magnesium replacement may be required as part of treatment, and serum potassium should be monitored. Finally, ethanol may be low or undetectable in the serum of patients with AKA because of decreased consumption in the days preceding presentation. In addition, evidence of alcoholic hepatitis is common in these patients, and serum transaminase activities and bilirubin are frequently increased.
The clinical case described by Platteborze and colleagues is an excellent teaching case that discusses the clinical and laboratory findings of a patient presenting to the emergency department with AKA. Laboratorians and clinicians must be able to recognize patients with AKA and be aware of the complexity of these cases and the impact of coexisting conditions on laboratory results.
Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article.
Authors' Disclosures or Potential Conflicts of Interest: No authors declared any potential conflicts of interest.
- Received for publication March 15, 2011.
- Accepted for publication March 21, 2011.
- © 2011 The American Association for Clinical Chemistry