Chandrasekara Hemantha, Fernando Pasan, Danjuma Mohammed, Jayawarna Chaminda
Acute Medicine, Endocrinology & Diabetes, Stepping Hill Hospital, Stockport, UK.
BMJ Case Rep. 2014 Feb 25;2014:bcr2013203263. doi: 10.1136/bcr-2013-203263.
Chronic alcoholism is a frequently unrecognised cause of ketoacidosis. Most patients with alcoholic ketoacidosis present with normal or low glucose, but this condition can present with hyperglycaemia. This can lead to misdiagnosis of diabetes ketoacidosis and, therefore, inappropriate treatment with insulin. We describe a 37-year-old Caucasian woman with chronic pancreatitis secondary to excess alcohol consumption, admitted with abdominal pain and vomiting, fulfilling the criteria for diabetes ketoacidosis. She was treated according to diabetes ketoacidosis protocol and experienced a hypoglycaemic attack within an hour of initiation of insulin. On review of her history, she was found to have three similar episodes over the past 12 months. Alcoholic ketoacidosis can present with hyperglycaemia due to relative deficiency of insulin and relative surplus in counter-regulatory stress hormones including glucagon. Awareness of the syndrome with a detailed history helps to differentiate alcohol ketoacidosis from diabetes ketoacidosis and prevent iatrogenic hypoglycaemia.
慢性酒精中毒是酮症酸中毒的一个常被忽视的病因。大多数酒精性酮症酸中毒患者血糖正常或偏低，但这种情况也可能表现为高血糖。这可能导致糖尿病酮症酸中毒的误诊，进而导致不适当的胰岛素治疗。我们描述了一名37岁的白种女性，因过量饮酒继发慢性胰腺炎，因腹痛和呕吐入院，符合糖尿病酮症酸中毒的标准。她按照糖尿病酮症酸中毒方案接受治疗，在开始使用胰岛素后一小时内发生了低血糖发作。回顾她的病史，发现她在过去12个月内有三次类似发作。由于胰岛素相对缺乏以及包括胰高血糖素在内的反调节应激激素相对过剩，酒精性酮症酸中毒可能表现为高血糖。了解该综合征并详细询问病史有助于区分酒精性酮症酸中毒和糖尿病酮症酸中毒，并预防医源性低血糖。
