Wrenn K D, Slovis C M, Minion G E, Rutkowski R
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Am J Med. 1991 Aug;91(2):119-28. doi: 10.1016/0002-9343(91)90003-g.
To further elucidate the clinical spectrum of alcoholic ketoacidosis (AKA).
A case series of 74 patients with AKA defined as a wide anion gap metabolic acidosis unexplained by any other disorder or toxin, including any patient with a history of chronic alcohol abuse. The setting was the Medical Emergency Department at Grady Memorial Hospital in Atlanta, Georgia, a university-affiliated inner-city hospital.
AKA is a common disorder in the emergency department, more common than previously thought. The acid-base abnormalities are more diverse than just a wide-gap metabolic acidosis and often include a concomitant metabolic alkalosis, hyperchloremic acidosis, or respiratory alkalosis. Lactic acidosis is also common. Semiquantitative serum acetoacetate levels were positive in 96% of patients. Elevated blood alcohol levels were present in two thirds of patients in whom alcohol levels were determined, and levels consistent with intoxication were seen in 40% of these patients. Electrolyte disorders including hyponatremia, hypokalemia, hypophosphatemia, hyperglycemia, hypocalcemia, and hypomagnesemia were common on presentation. The most common symptoms were nausea, vomiting, and abdominal pain. The most common physical findings were tachycardia, tachypnea, and abdominal tenderness. Altered mental status, fever, hypothermia, or other abnormal findings were uncommon and reflected other underlying processes.
AKA is a common disorder in chronic malnourished alcoholic persons. The acid-base abnormalities reflect not only the ketoacidosis, but also associated extracellular fluid volume depletion, alcohol withdrawal, pain, sepsis, or severe liver disease. Although the pathophysiology is complex, the syndrome is rapidly reversible and has a low mortality.
进一步阐明酒精性酮症酸中毒（AKA）的临床谱。
对74例AKA患者进行病例系列研究，AKA定义为无法用任何其他疾病或毒素解释的宽阴离子间隙代谢性酸中毒，包括任何有慢性酒精滥用病史的患者。研究地点为佐治亚州亚特兰大市格雷迪纪念医院的医学急诊科，这是一家大学附属的市中心医院。
AKA在急诊科是一种常见疾病，比之前认为的更为常见。酸碱异常比单纯的宽间隙代谢性酸中毒更为多样，常包括合并代谢性碱中毒、高氯性酸中毒或呼吸性碱中毒。乳酸酸中毒也很常见。96%的患者血清乙酰乙酸半定量水平呈阳性。在测定酒精水平的患者中，三分之二的患者血液酒精水平升高，其中40%的患者酒精水平与中毒相符。就诊时常见的电解质紊乱包括低钠血症、低钾血症、低磷血症、高血糖、低钙血症和低镁血症。最常见的症状是恶心、呕吐和腹痛。最常见的体格检查发现是心动过速、呼吸急促和腹部压痛。意识改变、发热、体温过低或其他异常发现并不常见，反映了其他潜在病情。
AKA在慢性营养不良的酗酒者中是一种常见疾病。酸碱异常不仅反映酮症酸中毒，还反映相关的细胞外液容量减少、酒精戒断、疼痛、脓毒症或严重肝病。尽管病理生理复杂，但该综合征可迅速逆转且死亡率低。
