Gerrity Ryan S, Pizon Anthony F, King Andrew M, Katz Kenneth D, Menke Nathan B
Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Emerg Med. 2016 Oct;51(4):447-449. doi: 10.1016/j.jemermed.2015.05.048.
Alcoholic ketoacidosis (AKA) is a complex syndrome that results from disrupted metabolism in the setting of excessive alcohol use and poor oral intake. Dehydration, glycogen depletion, high redox state, and release of stress hormones are the primary factors producing the characteristic anion gap metabolic acidosis with an elevated β-hydroxybutyrate (β-OH) and lactate.
We present the case of a 47-year-old man who presented to the emergency department with metabolic acidosis and profoundly elevated lactate levels who had AKA. He recovered completely with intravenous fluids and parenteral glucose administration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should always consider the immediately life-threatening causes of a severe anion gap metabolic acidosis and treat aggressively based on the situation. This case highlights the fact that AKA can present with an impressively elevated lactate levels. Emergency physicians should keep AKA in the differential diagnosis of patients who present with a similar clinical picture.
酒精性酮症酸中毒（AKA）是一种复杂的综合征，由过度饮酒和口服摄入不足导致的代谢紊乱引起。脱水、糖原耗竭、高氧化还原状态和应激激素释放是导致特征性阴离子间隙代谢性酸中毒伴β-羟丁酸（β-OH）和乳酸升高的主要因素。
我们报告一例47岁男性病例，该患者因代谢性酸中毒和乳酸水平显著升高就诊于急诊科，诊断为AKA。经静脉补液和胃肠外给予葡萄糖后，他完全康复。
为什么急诊医生应该了解这个病例？：急诊医生应始终考虑严重阴离子间隙代谢性酸中毒的直接危及生命的病因，并根据情况积极治疗。该病例突出了AKA可表现为乳酸水平显著升高这一事实。急诊医生应将AKA纳入具有类似临床表现患者的鉴别诊断中。
